We all feel a sense of urgency to get control over this darned COVID-19. It has been encouraging to see just how seriously most of us have taken the advice of our Public Health authorities. Even those who thought this was making a mountain out of a mole hill at first are starting to realize that it is serious. It’s scary to watch what is happening in Europe.
Our schools, restaurants, theatres have been closed. We are staying home in droves and our numbers in Canada are still going up. I’ve been asked why that is so if we are trying so hard to comply with the Social Distancing advice. We are sacrificing and not (yet) seeing a benefit. What gives?
There are a few things we have to keep in mind. This virus has been in our community, hovering unseen for a few days or maybe even weeks. It has an incubation period of around 5-7 days and maybe even up to 14 days. It can remain viable and infectious on shared hard surfaces for a few days. This means that even before we started the Social Distancing in earnest, there were some of us who had been exposed, maybe thought it was a cold, and unwittingly spread it to others. So even if we all locked ourselves up 100% it would take a couple of weeks to know whether that strategy was working because some of us would come down with symptoms from being exposed prior to our isolation. We have to be patient and persistent in order to see the results of this effort.
Secondly, we have had an influx of patients who have come home from other countries. Initially this was Canda’s main source of new infections. Unfortunately, before they were aware they were sick, they were able to pass it on. So we are getting a bit of a surge from that source and their contacts. Hopefully this will not blossom again when we have an influx of people coming home from winter vacations, March break or international travel. IT IS IMPERATIVE THAT PEOPLE WHO ARE RETURNING TO CANADA FROM ANY OTHER COUNTRY SELF ISOLATE FOR 2 WEEKS. THIS MEANS STAYING AT HOME. DO NOT EVEN GO TO THE GROCERY STORE. HAVE SOMEONE DO GROCERY OR PHARMACY RUNS FOR YOU AND LEAVE YOUR ITEMS AT YOUR DOOR. Without this cooperation from our returning friends and relatives, we will expect another surge and wider spread.
Another thing we have to keep in mind is that we are trying to flatten the curve but we can’t elminate it. There will be infections. But can we keep a handle on them enough to adequately maintain our health care system so we can look after ALL our people, not just the COVID-19 patients.
The graph below shows how rigid restrictions have been effective in South Korea, Hong Kong and even China. Reported new cases in China in the last 24 hours have been less than in Canada (13 in China as opposed to over 50 in Canada.) Their restrictions have been dramatic and very rigidly enforced for a month or so. But they are winning. We want, a month from now to be winning as well.
I have been watching the numbers on Worldometer that are updated daily. If you are anxious about COVID, maybe you would prefer not to look at these. They show daily numbers – total cases, number of new cases in the past 24 hours, number of new deaths, total number of deaths and number of people who have been diagnosed and recovered. The last column, the number of cases per million population, is the one that interests me most and will be the one that we want to see level off if our management is being effective. Currently Canada has 17 cases per million population. Compare that to Italy where that figure is a startling 591. Our cases per million number will rise quite a bit over the next two weeks but if we are successful it should start to become more stable. That’s what flattening the curve means.
Realistically, we should prepare ourselves that the restrictions are not just going to be a 2 week thing. We are in this for the long haul. It is going to take several weeks or even a few months to get this to a manageable level. I can’t imagine that schools will reopen before the end of this school year. We will have to adopt these principles of Social Distancing for the next foreseeable future. Eventually we will find a medical treatment for this, I think. Immunization will be developed eventually as well. With time, there will have been enough people who have had the virus and recovered with some natural immunity to lower the prevalence and thereby lower the potential of spread. We need a concerted effort from everyone to tackle this. It will sort out. But it will take time. Hang in. Stay the course.
For a bit more on Flattening the Curve and Social Distancing, check out my last blog article here.
John A Geddes MSc MD CCFP
Kingston, Canada
March 18, 2020
johnageddes 
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Thanks John. Hope you were able to share my 15min relaxation post. People are going to need this in next few weeks
I am so sorry…people are not social distancing. Many of us are, but a lot of people consider this “exaggerated.” We somehow need to get the word out. I also think that people who have been in the States may have received different messaging and just be acclimatizing to the Canadian stance on this. I think targeted messaging at places such as Walmart and Giant Tiger could be very very useful. Don’t drive past the parking lots at 4:00pm. You’ll have trouble sleeping. I have a lot of compassion for these folks who are just not getting the project yet, but we somehow need to work as a big team.
You are right, Maggie. Teamwork is the key. I think we all, and I include myself in the “all”, have trouble grasping the scope of this. We have never seen anything like it in our lifetime. And it is really hard to stay two metres away from everyone when getting some groceries, for example. In the very short run this might be doable without some sort of very draconian edicts from government like they have had in China or Spain and Italy. I think the scope of this is overwhelmingly difficult to understand. But if we can even put a huge dint in the number of cases by minimizing contact or potential spread at all it will help. The next couple of weeks will tell us, in Canada, if we have been able to make any difference with whatever behaviours we have attempted to change. Thanks for your comment. Dialogue about this is important.