What happens after the pandemic curve flattens?

Posted on Friday, April 3, 2020

Author: Prof. Michael Wolfson

Michael Wolfson

Faculty Affiliate, ISSP ​​​​​​
Member of the Centre for Health Law, Policy and Ethics, uOttawa

Originally published by The Globe and Mail on March 23, 2020

Many governments, including Canada’s, have taken too long to recognize the seriousness of the coronavirus pandemic when even days of delay can have large effects on the ultimate death toll. Our governments are only now recognizing that successfully flattening the epidemic curve means that we could be self-isolating for more than just a month or two.

Planning for the phase after – the time we begin relaxing the social-distancing measures – can and should start happening now.

If this relaxation is not done very carefully, the epidemic will simply resume. During the 1918 Spanish flu epidemic, which killed tens of millions worldwide, some cities, such as St. Louis, quickly instituted rigorous social distancing, while others, such as Philadelphia, did not. Both had resumptions of the epidemic after their social distancing and quarantine efforts were relaxed.

At present, a major issue is that we do not even know, in Canada and in most other countries, how many individuals are infected. We know how many cases have been reported, but these tend to be individuals with more than very mild symptoms. Various studies have estimated that for every reported case, there could be anywhere from 10 to 100 unreported cases.

Successfully limiting the spread of the virus is possible, as we can see in Wuhan, Singapore, Taiwan and South Korea. We can avoid the catastrophe unfolding in parts of Italy, where doctors are now having to decide who among their gravely ill patients can have their life saved with a ventilator.

But how will we know when and how to begin relaxing the very stringent social-distancing measures now being implemented, and allow Canadians to safely resume their daily lives without fear of getting sick, and without the risk of infecting anyone else?

For evidence-informed public-health policy, we need accurate information.

There is an international movement to develop smartphone apps that, with big data analytics, could provide critically needed real-time information to help track the pandemic. But serious options quickly run into questions of protecting personal privacy, especially with the public’s growing concerns about the behaviours of high-tech firms such as Google, Facebook, Amazon and Twitter.

So, is there a way, in Canada, to be both sensitive to very real concerns about personal privacy and use the obvious potential of social-media-type apps?

In principle, individuals with immunity could be issued a “green card” authorizing them to resume fully all their social activities. On the other hand, those who are infected would have a “red card,” while those who are still susceptible would be in a “yellow” state. In fact, China is implementing a system like this using a smartphone app already. If your phone shows red, your freedom is highly restricted.

Obviously in Canada, surveillance measures would have to be compliant with protections guaranteed under the Canadian Charter of Rights and Freedoms and relevant federal and provincial privacy laws. But there would be major benefits to developing this kind of data infrastructure to manage both the current and subsequent phases of the pandemic.

Public-health policy and implementation need smart ways to manage the relaxation of COVID-19 containment measures. This includes being able to quickly, in real time, identify clusters of new infections and isolate them; and to monitor people arriving from outside the country in case they become infectious.

Monitoring the movements of any already infected individuals will also be necessary in order to enforce isolation as the large pool of Canadians who would still be susceptible to infection returns to more normal social life. Canada’s current infectious-disease surveillance data flows are simply not up to the standards of countries such as Taiwan.

Still, there are very serious trade-offs here. The more detailed the data collected, the more sophisticated the evidence that can be produced to inform smart public health policy. But at the same time, more detailed data collection will be more invasive of individual privacy.

Being able to deploy this kind of real-time geographically detailed infectious disease surveillance requires serious planning by Canadian governments and key researchers now.

It is not too soon to begin discussing where to strike the right balance.

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