This is not good Epidemiology

6 weeks from the WHO declaring a worldwide pandemic and with New Zealand announcing they are stepping down their restrictions one level (we’ll get to what that means later), there has been more discussion about easing restrictions. In particular, people are beginning to speculate on timelines for this easing. There seems to be some incongruence with events being canceled through August, discussion of courses going online in September, yet also talk about things ‘getting back to normal’ as early as June.

So which is it? How do we know?

I’m going to open by saying I am not an epidemiologist, I have no training in pandemics or virology, and everything I share is simply my speculation based on data I’m looking at. Take it entirely with a grain of salt, this is not good epidemiology. This is not the opinion of an expert. I welcome being proven wrong now or later. However, I wanted to provide some context regarding my current thoughts on the timing around easing restrictions.

I speculate that the timing around easing restrictions will be long, and the easing will be slow.

I don’t think I bring pessimism to this speculation, rather there are a couple of graphs that make me feel that we have quite a ways to go here. The first one is:

Look at where Canada is and notice we are still on an upward trajectory on a logarithmic scale. Now look at New Zealand at the bottom. Look at the post-peak trajectories of all nations and apply any one of these angles to where Canada is now. If our new cases were to start declining immediately, today, even applying any single one of those trajectories puts us at around 60 days to be at where New Zealand is at today. And that’s assuming the best case scenario that things get better for us from today forward. So let’s say end of June for example. I scribbled a random line on the chart to show what I mean:

A correct angle on the random line probably puts us well into July.

Here’s another helpful graph:

Short of a miraculous cure, although we are tipping the line, there’s a heck of a way to go for it to get to the bottom of the chart.

Essentially, from where we are today we’re talking at least a couple of months before COVID-19 deaths become minimal, and this is with all things remaining equal (and assuming our trajectory follows others). [This is part of why the U.S. approach of late distancing is going to be so much of a problem, the length of their curve stretches beyond the end of any graph, the higher the initial peak the longer the recovery. They are not going to be an ideal neighbour to say the least.]

So let’s talk about where New Zealand is at. Having achieved near zero new cases they have reduced their emergency level from 4 to 3 (https://covid19.govt.nz/latest-updates/new-zealand-be-at-alert-level-3-from-tuesday-28-april/). What does this mean? Essentially a couple of things: your family can expand it’s bubble as long as you keep your bubbles mutually exclusive. So, you can start hanging out with grandparents or a neighbour as long as the grandparents and neighbour have only started hanging out with you and have not added their uncle and co-workers into their own bubble. Secondly, some businesses can re-open with no contact in place. Importantly, this is not a return to normal, it’s a slight easing on restrictions.

Why the cautious approach in New Zealand? Look at the China curve: when you ease restrictions you have secondary outbreaks. Until we can test the whole population (for immunity or infection) and perhaps have N95’s available for all, or until a vaccine is available, it’s about minimizing infection versus hoping it will fully go away. We have no indication yet that supply chains are in place for mass testing and mass PPE any time soon.

So, let’s go back to my initial comment that Canada is at bare minimum two months out from minimal new cases (based on holding up a pencil against someone else’s graph, as a reminder, not quality science). Yes, we could begin easing restrictions before the cases get this low, we could also do this regionally/locally. The challenge is, the earlier you ease, the bigger that subsequent wave. While people may begin to press the government to lift early, how many human lives are worth opening a few more stores or expanding our bubbles by 5 more people? Who would want to be the Premier or Prime Minister who decides to shift from minimal deaths to a moderate level of deaths?

So, back to my personal position that this is going to last a while longer. I suspect that even if we do have a best case scenario in decreasing infections it will still be a while before we’re low enough to be comfortable in increasing risk. And, once we start increasing the risk, I suspect it will be slowly and cautiously. This is why I think we’re still talking many more months here.

Conclusion:

Why, as a researcher and scientist, would I dare speculate in a field outside of my expertise? While positivity and enthusiasm are good, I worry that being over ambitious about a return to normal may push governments to making rash decisions. With a child who is high risk and two grandparents in long-term care, this risk is very real to me and my family.

So, stay positive, stay happy, but stay patient. Allow our governments to make decisions about the pandemic based on the best expertise of our medical professionals and respect those decisions. Stay physically distanced but socially connected. We all miss normal life but as I saw it stated on Twitter, “It’s better to not have your hair cut than to have it cut by a mortician.” Stay strong.

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2 Responses to This is not good Epidemiology

  1. Aldous Smith says:

    I like your reasoning, Abe. And the insights re. NZ, compared to us, are valuable. Yes, absolutely, we need to be patient and strong. Thanks for this. I hope all your family gets through this in good health.

  2. While I agree whole heartedly with what you are saying, my biggest concern is the lack of mental health support and resources for disadvantaged families to maintain this type of physical distancing without causing significantly more trauma to themselves as individuals and their families. Just like COVID-19, there has been very little assessment into how people are doing mentally because people are too afraid to go to the hospital for support and many community agencies have either shut down or are not taking on new clients. There is little to no direct service being provided beyond telephone helplines with volunteers and staff who are not trained to deal with the severity of psychiatric disorders falling at their feet. The government is calling mental health and illness the second wave but it’s not. It already here and it is an invisible virus just like COVID-19 that also needs to have crisis management teams in place. People with pre-existing psychiatric disorders and trauma, frontline workers who are scared to work daily but go anyways, and those who have lost loved ones to COVID-19 are going to suffer the most with long-term effects that will be felt for many years to come. Many people think the stress will be over once the restrictions are lifted but they will soon realize that we as a community, province and country will not return to the same normal. Many kids and adults will be too fearful to return to school or work, will need a lot more time to heal, and more mental health sick leave will need to be utilized as a result. The government needs to take more initiative in minimizing the harm caused by physical distancing so that society can transition easier back once this crisis is over. The mental health curve should have been planked simultaneously while we tried to flatten the curve of the virus spread. However, they are not mutually exclusive problems and we should be preparing for this surge in mental health in which there is no real infrastructure in place to handle the volume (nor is the medical system have the capacity to deal with either). The most highly trained professionals are psychologists and 90% of college members are in private practice due to many cuts made in the past. We should be helping with diagnosis and diverting people out of the ER as much as possible. Just like people who are homeless, we have not provided many disadvantaged groups with the ability to walk away from this medical pandemic unscathed or the ability to follow these physically distancing rules successfully. I just hope the government provides a more clear directive as many mental health workers have been laid off or are not being utilized effectively to help further with prevention or reducing the trauma and high levels of anxiety and depression that is spreading and becoming more severe as a direct result of these physically distancing measures. But let me be clear, I am not saying we should divert attention from the medical system or stop physical distancing. Rather, we need to put mental health at the forefront as a health care issue that can also help with an overburdened medical system. Mental health professionals that reside in schools have quick and easy access to many vulnerable students and families (and also employs the majority of mental health professionals in the public sphere). We should be utilizing both their skillset and ability to help as they have not been laid off during this difficult time. However, everyone seems stuck in a holding pattern and I wonder how many more incidences like the tragedy in Nova Scotia need to happ n before people pay more attention to these pressing issues.

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