Doctors across Canada call for #COVIDzero plan

The goal of COVIDzero is to reduce community spread with the objective of getting case counts down to as close to zero as possible.

Laura Hensley November 25, 2020
COVIDzero Canada

A pedestrian wearing a mask walks past a mural on Toronto’s Church Street during the Covid 19 pandemic, Thursday October 8, 2020 PPeter J Thompson/National Post

As COVID-19 case counts continue to rise across Canada, a group of local health experts are looking to countries that have better controlled the virus and are calling for a more aggressive elimination strategy here at home — a plan called #COVIDzero.

The goal of COVIDzero is to reduce community spread with the objective of getting case counts down to as close to zero as possible. The idea is that a unified, nationwide plan will prevent more illness, deaths and economic fallout. COVIDzero means ramping up infection control measures, like testing and contract tracing, and preventing cases from moving from one part of the country to another.

One of the leading proponents of COVIDzero is Dr. Andrew Morris, a Toronto-based infectious disease specialist and professor of medicine at the University of Toronto. Morris recently tweeted a thread about what COVIDzero would look like Canada, writing that the aspirational strategy “sets a high bar for a country that has failed to set a bar.”

“Every winning country battling COVID has a #COVIDzero elimination strategy and mindset,” Morris wrote.  “None are eliminating it sans vaccine. But they’re acting like they are, with economies returning, life normalizing, and few deaths. Canada [and] Canadians can achieve this if we set our mind to it.”

What does a COVIDzero plan look like?

The key components of a COVIDzero strategy are rigorous test, trace and isolate practices, clear messaging, strong government leadership, societal cohesion and aggressive prevention measures. 

Testing, contact tracing and isolating is key because it helps curb the spread of COVID-19 and prevents people from bringing the virus to lesser-affected parts of the country. Contact tracing also lets people who may have been exposed know to isolate and get tested, stomping out further transmission. Authorities are not sure where most transmission is occurring in Canada as data is limited, making it hard to know exactly where people are contracting COVID-19. 

Dr. Josh Ng-Kamstra, an Alberta-based general surgeon and intensivist, tells Healthing that rising case counts in many provinces “have overwhelmed, or threaten to overwhelm,” the current capacity of contact tracers. In October, soaring case counts in Toronto prompted authorities to scale back on some of their contact tracing efforts to instead focus on high-risk situations as the amount of work became unsustainable.

“In Alberta, the vast majority of new cases are from an unknown source. This suggests rampant community transmission, and an inability to invest enough time in each new case,” Ng-Kamstra explains. “Urgent action is needed to stave off a health system catastrophe.”

Looking to other countries

Part of COVIDzero’s response is learning from other countries that have been more successful at managing the virus. Morris points to countries like New Zealand, Vietnam, China, Australia and South Korea, which have relied on measures like efficient contact tracing programs, widespread testing and stringent lockdowns. 

The key components of a COVIDzero strategy are rigorous test, trace and isolate practices, clear messaging, strong government leadership, societal cohesion and aggressive prevention measures. 

Ng-Kamstra says innovations in testing, like the antigen-based mass testing that has shown early success in Slovakia, could be used in Canada. “Such innovations are insufficient on their own, but they can turn things around, and quickly,” he says.

But what works in one country doesn’t necessarily mean it will work the same way in Canada. Countries like New Zealand and Australia have smaller populations and are also islands. Canada also has a much different climate, which pushes people indoors during winter, Ng-Kamstra says. 

This is something Dr. Irfan Dhalla, an associate professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation, acknowledged in an interview with the New York Times. Dhalla, who wrote about a COVIDzero strategy back in May, isn’t suggesting Canada copies others’ response plans to a T.

“We should look at COVIDzero as a rallying cry for a better approach,” Dhalla told the Times. “I don’t personally support a lockdown of the nature that occurred in Melbourne. I think we should keep schools open.”

What stays open and what closes?

Stricter policies and aggressive closures are necessary in order to control COVID-19, proponents of COVIDzero say. They argue provincial or municipal guidelines that constantly change, going from allowing certain businesses to open, then forcing them to close, gives way to fluctuating COVID-19 case counts. 

Urgent action is needed to stave off a health system catastrophe

Instead, Morris argues that stringent closures will help get case counts down to a level where the economy can come back and not experience the ups-and-downs of closure orders. He tweeted that the serious restrictions many Canadians are facing are out of necessity, and that the more aggressively we act — “and the more compliant the public — the faster the numbers fall.”

“If you are really aggressive, you can get close to zero by about eight to 10 weeks in worst-hit areas, but 12-14 weeks is more realistic for most,” he tweeted.

Dhalla told the Times that schools should remain open, something Ng-Kamstra says most people support. Investing in smaller class sizes and better ventilation can help lessen transmission while schools are open. 

“Schools are tough, we know that closing schools has a significant effect on virus transmission, so in the worst-affected areas school closures are an emergency brake,” he says. “But closing them will have immediate negative consequences for the wellbeing of children, and the potential for major long-term effects to their educational trajectory.”

Ng-Kamstra also says the more coordinated the COVIDzero response is across the country, the better.

Canada is large, and pandemic response plans across the country have varied. This means it’s important that regions have clear, cohesive measures that address outbreaks in their communities. And while this means “specific policies needed to get to COVIDzero in various parts of the country will differ somewhat,” the goal and principles of COVIDzero remain the same: stop the spread. 

“We need careful attention to the movement of people between areas of high and low COVID spread,” says Ng-Kamstra. “Success in one area can easily be undone by the importation of cases from an area where community transmission is high.”


Clear communication and strong leadership 

Because there is so much regional variation in COVID-19, clear, science-based messaging is needed. People need to understand public health recommendations and government rules, and this messaging needs to make sense — something experts previously stressed to Healthing

Health experts want COVIDzero to be a slogan and take off on social media the way other slogans, like #WeTheNorth, have. If people can get behind an idea together, the more successful it will be. That’s where the COVIDzero pillar of societal cohesion comes in.

“Aiming for #COVIDzero gives us a common goal,” Ng-Kamstra recently tweeted“The approach should be smart, innovative, and thoughtful. Zero doesn’t change, and we all understand what it means. That clarity is essential to getting through this together.”

He says that the federal government has a role to play in getting everyone behind the plan. It’s important that all Canadians can benefit from the health, social, and economic outcomes of a COVIDzero approach, he says.

“Federal leadership can use incentives to unify disparate provincial responses, and can help to navigate the thorny issues of interprovincial travel.”

No one left behind

An elimination goal cannot leave anyone behind, all proponents of COVIDzero stress. Morris tweeted that the strategy needs to support “everyone who will be adversely affected in the pursuit of zero.” This is something Dhalla also emphasized in his interview with the New York Times. 

Dhalla said he believes it’s necessary to end indoor dining in places where there’s high case counts, but that business owners and workers shouldn’t be punished for such closures. 

“Restaurant owners and the people who work in restaurants should undoubtedly receive support from the government, which means the rest of us,” he told the Times. “If we’re all in this together, that means we need to support people who lose their jobs.”

Dr. Isaac Bogoch, a Toronto-based infectious diseases physician and scientist, tweeted that it’s important there’s policies and supports in place that make sure workplaces that remain open are safe, like factories, and that there are “systems in place for paid sick leave.”

Ng-Kamstra takes this one step further, saying that most Canadian jurisdictions continue to fail in providing support for vulnerable populations that are affected both by the virus itself and by the measures needed to control it. These include people experiencing homelessness, people with addictions, and those working in public-facing or service jobs. Black, Indigenous, and people of colour — populations who are disproportionately affected by COVID-19 and other social determinants of health — must be supported, too.

Ignoring these people is a massive oversight and will not result in achieving wide-spread success. “Singapore’s early success in controlling COVID19 had a massive blind spot: the foreign workers who lived in crowded dormitories,” he says. “It was only when they recognized that supporting these workers was critical to pandemic control that they again got the virus under control.”

Laura Hensley is a writer with

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