School closures, more testing, aerosol education among options to curb B.C. infections: expert

One of Canada’s most prominent epidemiologists is urging policymakers to consider all the options available to curb the spread of COVID-19 before B.C.'s infections get harder to control.

Dr. David Fisman points out that the day-to-day numbers fluctuate and it’s important to look at the overall trend in infections as they continue to rise.

But health officials have been reluctant to pull available levers to control the spread of the coronavirus.

Restrictions had remained largely the same from mid-November, when the province enacted a social lockdown prohibiting gatherings with those outside your household, with some exceptions for people who live alone, until Monday when the province shut down indoor dining as part of a “circuit breaker.”

“I don’t think you will keep doing what you’re doing right now because unfortunately what happens with this disease is people say, ‘It’s no big deal, it’s no big deal,’ and suddenly it’s a big deal. I think it’s Ernest Hemingway who said he lost his money two ways: slowly, then all at once,” he said, citing exponential growth.

The fact that British Columbia hasn't slowly been "turning up the dial" of infection control measures in recent weeks in response to rising case counts leads Fisman to believe more dramatic measures may be required.

“You can’t play chicken with this virus, it will get you, and I think that’ll probably come — and then you’re in the situation where you’re reacting and turning all the dials in the other direction at once and locking things down.”

Fisman is an epidemiology professor at the Dalla Lana School of Public Health at the University of Toronto and worked as a public health officer in Ontario at the same time as Dr. Bonnie Henry; he in Hamilton, while Henry was in Toronto.

While his home province announced a sweeping “emergency brake” lockdown starting Saturday, Fisman said the fact B.C. hasn’t enacted as many restrictions so far leaves decision-makers with a lot of options ranging from updated COVID education to wildly disruptive school closures.

“I do look at some of the messaging in B.C. with some concern because we’ve all learned a lot this past year and if you still have the same ideas about how this works and how it’s transmitted a year on, when we’ve learned so much, that to me is problematic because the knowledge is not the same,” Fisman pointed out.

Particularly, he said, in terms of the importance of recognizing the significance of aerosolized COVID transmission as opposed to focussing on droplets or surfaces.

Fisman also urged an expansion of B.C.’s testing, which is significantly lower than most provinces and the subject of ongoing advocacy by one of Vancouver’s most outspoken epidemiologists, Dr. Brian Conway, president and CEO of the Vancouver Infectious Disease Centre.

It was the first thing he brought up when CTV News asked what more the province could do to bring down infection rates.

“We’re doing two-thirds the testing of other provinces and it’s not necessarily been made clear to everyone why more testing wouldn’t be helpful,” said Dr. Brian Conway, who also advocated for regional restrictions based on local issues and spread. “These have worked in other jurisdictions so let’s understand if this is the time to do it here.”

For example, on Wednesday British Columbia found 1,013 positive samples out of just 7,579 tests, while Quebec identified 1,025 cases in 29,840 tests. Quebec has less than double the population of B.C. Ontario, with nearly triple B.C.’s population, conducted 36,071 tests the same day and found 2,333.

“I’m not sure where we would expand testing and we do have quite a lot of testing being done,” insisted Henry when CTV News asked about testing levels on Thursday. “We have asymptomatic testing being done where it's appropriate. Part of the reason that we're seeing higher per cent positive in the north, for example, is because we are testing the people who are most at risk, and so that's appropriate.”

Henry has also been cold to rapid testing, which Fisman points out has been used to great advantage in Atlantic Canada, where health officials have had tremendous success in quashing clusters and keeping infection rates consistently low.

The elephant in the room, however, is whether a shutdown of the school system is on the table. Henry only enforced a mask requirement for grades 4 to 12 on Monday, after confusing language that had left teachers scrambling for clarification. This is in in stark contrast to Ontario, where health officials started the school year with such a mandate and expanded it to every public school student in January.

Fisman said schools are one large gathering that's hard to address, describing a possible closure as a "house of cards" that impacts kids and their parents.

"We would like to avoid that, and I think you have a ton of wiggle room in terms of how you could do better with schools,” he said.

He pointed out that the masks in addition to smaller class sizes, open windows for ventilation and even taking advantage of mild weather for outdoor learning could all help reduce the chances of transmitting COVID in the classroom.

“At the end of the day the data is clear: closing schools reduces reproductive numbers all over the world, including Canada, because we’re not different,” he said. “We can argue about whether that’s because there’s less kid interaction or whether that’s because parents behave differently.”

Unless there’s a sudden surge in cases, it’s likely the public health officer won’t make any dramatic changes to restrictions or public health orders for a couple weeks, since it can easily take that long to assess whether the in-person dining and fitness closures will have an impact.

It can take five to seven days for symptoms to appear after exposure to the virus that causes COVID-19, and Henry has often said that the daily case numbers reflect infections that took place one to two weeks earlier.

Finally, both Fisman and Conway brought up a significant concern, which has been B.C.'s seeming reluctance to adopt measures and strategies from outside the province. They are advocating learning from the successes of other provinces and countries that have had success pulling the levers of messaging and restrictions in such a way that the public understands and responds to the risks in their communities, while being guided by widespread testing in labs and through rapid tests, to identify where and how the virus spreads.

On several occasions CTV News has brought up other public health strategies and asked whether they should be applied to B.C. -- for example the colour-coded notification system in Atlantic Canada and Ontario -- and has received a similar response from Henry each time. 

"We all have our own pandemic,” she has often said.