As Canada moves to start easing lockdown measures, experts say there are key lessons we can learn from other countries to avoid risking a sudden spike in new COVID-19 cases.
Countries like South Korea and Germany lifted some restrictions and have faced setbacks — but also did some things right.
What they’ve shown is that easing measures could result in new outbreaks and a return to restrictions if not handled correctly. Experts say effective testing, tracing and isolating of cases need to be put in place before reopening.
“Shutting your eyes and trying to drive through this blind is about as silly an equation as I’ve seen,” Dr. Mike Ryan, the World Health Organization’s top emergencies expert, said this week.
“And I’m really concerned that certain countries are setting themselves up for some seriously blind driving over the next few months.”
South Korea’s nightclub outbreak
South Korea moved quickly to flatten its curve of COVID-19 cases, focusing on aggressive testing and elaborate contact tracing to track and isolate new cases.
The efforts paid off, setting an example for the world on how to effectively contain the spread of COVID-19 despite early signs the country could be overwhelmed.
But a recent cluster of cases at a nightclub district in Seoul is calling into question whether the country lifted certain lockdown restrictions too soon.
On May 6, a 29-year-old man tested positive for COVID-19 after visiting five different nightclubs in the Itaewon district of the city on the night of May 1 and early hours of May 2.
Officials have so far identified 10,905 people who were in the Itaewon area when the cluster of cases is believed to have occurred, and have tested 7,272, including family members or co-workers of clubgoers, with 1,982 still outstanding.
Health officials say more than 100 new cases have been tied directly to the Itaewon outbreak, heightening fears of a second wave of COVID-19 in South Korea.
In response to the recent spike in new cases, Seoul Mayor Park Won-soon ordered 2,100 nightclubs and bars closed immediately.
“Carelessness can lead to an explosion in infections,” he said Saturday, adding the order would stay in place indefinitely.
“It’s not over until it’s over,” President Moon Jae-in added on Sunday. “We must never lower our guard on epidemic prevention.”
Raywat Deonandan, an associate professor at the University of Ottawa and a global health epidemiologist, said that while the incident was unfortunate, it could have been much worse.
“The positive is that they were able to track this person and eventually get a handle on those outbreaks and prevent them from becoming epidemics,” he said.
“The goal here is to prevent a handful of cases from becoming an outbreak and prevent an outbreak from becoming an epidemic — and they succeeded.”
Deonandan said South Korea has been able to control its rate of COVID-19 cases through extensive digital contact tracing and rapid testing in a society that is compliant to surveillance measures.
For instance, guests at the Itaewon nightclubs signed entry logs. Canada has so far not introduced any methods for tracking people out in the community and would be “at a loss” in a similar situation, Deonandan said.
“We’d have a full-blown public health emergency, possibly, rather than just one person wandering into a few places that we can quickly tamp down.”
Germany keeps its foot on the brake
Germany focused the bulk of its containment efforts on extensive testing to get a handle on its true caseload and combat regional outbreaks of COVID-19 — seeing its daily numbers drop in recent weeks as a result.
The country hit its goal of more than 100,000 tests per day late last month, despite some criticism it counted some tests prematurely, and lowered the number of new infections per day to under 1,000 before lifting certain restrictions.
Shops can now fully reopen with increased hygiene and physical distancing measures, schools have been partially reopened, Bundesliga soccer matches will resume this weekend and members of two different households can meet together.
But German Chancellor Angela Merkel said last week that an “emergency brake” will be applied if a spike in new COVID-19 infections happens anywhere in the country.
Early signs show Germany may need to consider pumping the brakes sooner rather than later, as the reproduction rate of the virus rose just days after easing restrictions.
Germany now has a basic reproduction number, or R0, over one — meaning each infected individual transmits the virus to more than one person.
Countries that can keep their R0 below one are thought to be decreasing their rate of new cases, which signals they may be in a better position to reopen.
But with its R0 above one, there is growing concern as to whether Germany reopened too quickly.
Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital, said Canada’s R0 varies on a day-to-day basis — but even if it were to remain below one, there are other measures that need to be in place to reopen safely.
He said Germany has also done an excellent job of communicating to the public the risks of reopening, which is something Canada could do better as we look to lift restrictions.
“Canadians should be informed and even reminded that opening up the economy and gradually lifting these public health restrictions is not a linear path forward,” he said.
“We may make progress, but of course if there are outbreaks in certain settings, the public health authorities may have to clamp back down, and we may have to regress just like what we saw in South Korea and in Germany.”
Canada needs to learn from others’ mistakes
Canada’s daily caseload has dropped significantly since the start of the pandemic, and physical distancing measures have prevented hospitals from being overwhelmed. But while our curve has flattened, it has not yet dropped.
Deonandan said a one-size-fits-all approach to testing, contact tracing and surveillance is not possible globally, and what has worked for other countries may not necessarily work for Canada due to our geographical, cultural and societal differences.
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He added that while Canadians may be receptive to physical distancing and widespread testing measures, they may be less inclined to allow extensive surveillance through digital contact tracing, like South Korea.
“It would be foolish of us not to take a deep look at what other countries have done. It would also be foolish of us to assume wholesale that their solutions will work for us,” he said.
“So we have to balance the lessons we learned abroad with the social tolerances that we have here.”
But Bogoch says that until we can scale up testing evenly across the country and expand contact tracing and surveillance measures dramatically, we’re still at risk of potentially serious outbreaks if we reopen.
“The whole goal is to have early detection systems and early warning systems so it doesn’t spiral out of control,” he said.
“You need to catch an ember before it turns into a flame.”