So… When Will Coronavirus End?

UPDATE: Some (sort of) good news if you live in Ontario or Quebec. This week, both provinces announced plans to reopen their economies — eventually. In Quebec, elementary schools and daycares will reopen by May 19 and certain retail stores will be back in business as early as May 4, although social-distancing measures will continue. Ontarians, meanwhile, can't count down to a firm date quite yet. “The framework is about how we’re reopening — not when we’re reopening,” said Ontario Premier Doug Ford in a press conference on April 27 where he announced the government's plans. “This is a road map, it’s not a calendar.”

Ford added that the province needs to see a decrease in the number of COVID-19 cases for a minimum of two weeks to consider lifting the lockdown. The three-step process to re-start the economy, when it happens, will look like this: opening some workplaces and allowing some small gatherings; then, opening of service industries and retail stores and some parks; and finally, allowing larger gatherings to take place.

Original story follows.

When will coronavirus end? It’s the question on everyone’s mind after weeks of isolation, one too many loaves of home-baked bread, and haircuts in desperate need of professional attention. As for the answer… well… to quote your ex’s favourite Facebook relationship status: “It’s complicated.” News that the virus has likely peaked in the worst-hit provinces (Ontario, Quebec, B.C.) is definitely cause for celebration. But it doesn’t mean a return to life as we know it knew it any time soon.

So what does it mean? What exactly are we waiting for? And when are these rules going to start loosening up a little? 

We all want to be able to circle a day on the calendar that says “So long to our collective nightmare.” But the reality is that “the end” will come in stages and what’s “normal” will continue to be re-defined as we hit incremental goals along the way. The peak that everyone is talking about this week is an important one. 

The peak that we are talking about here is peak community spread of coronavirus, which is assessed based on the number of new cases reported daily. So when a province says the virus has peaked (the number of cases are tracked provincially), it means that the daily numbers are no longer trending up. Instead, they are remaining somewhat steady (the “flat” part of flattening the curve) and should start to go down soon. 

It is great news. A month ago experts were predicting a peak number of coronavirus cases some time in May. The fact that Canada has arrived there a couple of weeks early means previous worst-case scenarios have been prevented both in terms of duration and severity. At least that’s the hope. As Toronto’s medical officer Eileen de Villa reiterated yesterday in a TV interview: “You can only really tell when the peak is once you’ve passed it.” What experts want to see is sustained levels of reduced transmission over a longer stretch, says Dr. Isha Berry, a doctoral fellow in epidemiology at Dalla Lana School of Public Health, University of Toronto. Since the lag period between transmission and reported cases of COVID-19 is about two weeks, making sure numbers remain stable over that period (and probably a couple extra weeks to be safe) will be the first benchmark before we start looking at loosening up social-distancing restrictions.

Another important statistic is the R0 (or R-naught), aka the number of people an infected individual will pass the virus along to in a non-vaccinated population, aka the thing that Kate Winslet’s character explains on the white board in Contagion. (What — you haven’t been binging pandemic movies?) The measles has a natural R0 of 12-18 (meaning without a vaccine, we would totally screwed), the regular flu is around 1.3 and COVID-19 “has a natural R0 of around 2,” says Dr. Berry. Thanks to social-distancing, hand-washing, and other precautionary measures, Canada has managed to bring that down to between 1.1 and 1.5 nationally (though it’s higher in places like Ontario and Quebec, and lower in Nova Scotia and Saskatchewan). In order to feel safe about loosening up on lockdown, we want to see the R0 below 1. 

Whoa, whoa, whoa. Those are three different questions that are going to vary based on geography, what kind of work you do, and exactly how badly you butchered that DIY fringe trim.

Trudeau has said that a partial return to work could be in place by summer, but that really depends on what kind of job you do. If it’s possible to do your work remotely, the likelihood of returning to an office in the coming month is pretty — er — remote. Whereas if you’re a sales person at a clothing store or a bricklayer, your return will come sooner. How soon is — again — a provincial matter. In Saskatchewan, where they have had relatively few cases and where population density is low, Premier Scott Moe has announced a five-stage plan to reopen the economy starting on May 4. He has said that gatherings of up to 10 people will likely be okay at that point, as long as physical distancing rules are observed. But Moe also stresses that the rules could easily tighten back up if the numbers climb back up. The technique will presumably be similar in all provinces when the time comes, but in Ontario and Quebec (two provinces that have seen the highest rate of cases and fatalities), we are not there yet. 

A lot of cottage-goers saw a glimmer of hope following Monday’s good news about reaching the peak. At one point Ontario Premier Doug Ford even hinted that the long weekend could be a good time to begin tentative reopening measures, but he has since clarified his comments, saying a lockdown lift before the unofficial opening of summer is “absolutely not going to happen.” 

Because, to put it in the clearest terms possible, reopening now in places that aren’t ready would almost certainly result in another outbreak. We need to wait for rates to go down and also for testing capacity to go up, which is the other piece of the puzzle and key to avoiding the dreaded second wave (and third and so on). “When we do relax the rules, we’re going to have more cases — that’s inevitable,” says Dr. Berry. So before that happens, we need to feel confident about our health-care system’s ability to “track, trace, treat, and contain.” Trudeau has confirmed that achieving higher testing will be an essential towards the nation’s return to any semblance of normalcy. This is another place where some provinces are lagging behind (Ontario, Quebec), while others are ahead of the game (Saskatchewan).  

That’s probably a little drastic, but we can look at what happens there next month to get a clearer picture of what re-opening might look like across the country. Stage one in Saskatchewan will permit “the resumption of non-essential medical procedures, and the reopening of provincial parks, campgrounds and golf courses." Assuming that goes okay (ie, tracking tracing, treating, containing), retail businesses will open in the second stage two weeks later and yes — that includes hairdressers. 

Because that’s about how long it will take to see the results of any one relaxation measure, whether it’s permitting small social gatherings, permitting certain professions return to work, or opening up playgrounds at your local park. If numbers go up, restrictions will tighten up again and that’s almost certainly how things will look for the foreseeable future with lower risk/low population activities like backyard BBQs entering back into the rotation sooner, and higher risk/high population activities like concerts probably on ice into next year. It’s going to be about finding balance between our health and economic stability, practicing disease surveillance, and buying time until we can get a vaccine, says Berry. 

Again, the estimates vary. Historically speaking, the fastest vaccine ever developed was for the mumps, and that took four years. But that was more than 50 years ago and we have made a lot of advancements. Dr. Berry notes that the fact that researchers were able to isolate the virus so quickly (a feat achieved right here Canada) is a good sign. Until then, our only option is non-pharmaceutical interventions like isolation, masks and — yes, this again — making darn sure you wash your hands.