'How to get a win-win': experts offer COVID-19 exit strategies

When the time comes to lift the COVID-19 restrictions, how should it be done? Is it possible to return to business as usual, and should that even be the goal?

"How can we go forward, rather than just revving everything back up? Let's see what we can learn," said Cheryl Camillo, assistant professor in the University of Regina's Johnson-Shoyama Graduate School of Public Policy.

Experts interviewed by CBC say planning should start now, even though most believe that day is months away.

"The question is how to get a win-win: reopen as soon as possible while mitigating the risk of a bounce-back," health policy analyst Steven Lewis said.

Camillo, Lewis and others agreed to outline potential coronavirus exit strategies. These include proposals to reopen businesses and schools in a matter of days, with one major caveat.

Restart gradually — most important services first

Camillo, who specializes in health reform, said the restrictions must continue for the foreseeable future.

When infection rates eventually fall and the curve has flattened, the government should consider a gradual approach to restarting society.

The government has already decided which services are essential and can remain open — hospitals, grocery stores, liquor stores, media outlets, construction companies and others. Phase two will involve opening the next most important services and businesses, she said.

This includes the growing backlog of elective surgeries and dental procedures, but also home and diabetes care, physiotherapy and other less obvious health services, she said.

It could gradually widen, but she said some services are obviously more urgent than others.

"For example, even though some people earn their livelihood from a tanning business, it is truly necessary?" Camillo said.

At a teleconference on Saturday, Premier Scott Moe said this phased in approach is what the province is considering.

Moe said the province is looking at lifting a number of restrictions and then actively testing the public and conducting contact tracing.

"If there's no significant increase in numbers with those restrictions being lifted, then you could breathe a sigh of relief and start to look at potentially the next phase of restrictions to be lifted," he said.

Experiment in select cities

Lewis, a Saskatchewan health policy analyst now living in Australia, said things look very good so far for the province but it's not yet time to relax.

Once infection and hospitalization rates have slowed over time, provincial and civic officials could pick a couple of mid-sized cities such as Yorkton or Moose Jaw, Sask., for some "real-time science," he said.

The first step would be a one-day random testing "blitz" in those cities, he said. If the tests show infection rates are low enough, open all businesses and lift restrictions there.

"I'd rather do a full-meal deal experiment in a few places. You can get answers without going whole hog across the entire jurisdiction," Lewis said.

"And the difficulty with the phased-in approach is it's hard for all of us to interpret the messages the same way. Simplicity is better."

Repeat the random testing in those cities a week or two later, Lewis said, then absent a worrisome "spike" in new cases, relax the rules in other locations and eventually the entire province.

Lewis said the data will be even more reliable if other provinces or countries take the same approach and share information.

Effective communication is essential, Lewis said. Those in neighbouring towns might be jealous of cities with functioning schools and businesses, while some in those selected cities could resent being used as guinea pigs.

"I think the public will be generous in accepting these messages. They have been up to now," Lewis said.

Open for business ASAP, but mask up

Saskatoon-based epidemiologist Mark Lemstra said the province can open most businesses, schools and other institutions across the province in the coming days, with safeguards.

Officials at each location must promise to follow all public health guidelines such as physical distancing, frequent hand washing and no large public gatherings such as concerts or spectator sports events.

Lemstra would add one more guideline: mandatory face masks at all times for anyone who leaves their home.

He said COVID-19 is droplet-based, and public health officials have recently agreed even home-made masks can significantly lower the risk of transmission.

Lemstra said the government could order 12 million basic surgical masks and give residents 10 each. If ordering in bulk, the masks would cost about five cents each for a total expenditure of $600,000, he said.

Lemstra said this amount is a pittance compared to the billions in damage to the province's economy.

"This is an option for a coronavirus that might have multiple waves over an 18 to 24-month period, and might linger on forever. We need to reopen Saskatchewan sometime soon — and a few million masks will allow us to do so," Lemstra said.

He said Canadians will have to temporarily overcome the social stigma of wearing a mask in public, but it's better than another Great Depression. Masks have also worked to minimize problems in Japan, South Korea, Hong Kong and Singapore.

There's one other important caveat mentioned by Lemstra, Lewis and Camillo: protect the vulnerable during these transitions.

The elderly, those with compromised immune systems or those with serious underlying health conditions must remain isolated until these measures are proven safe.

Lemstra noted in Italy, one of the hardest hit countries, the median age of COVID-19 fatalities was 80.5 years with an average of 2.7 other chronic diseases.

In Saskatchewan, the first three people to die of coronavirus-related causes were all elderly and had other medical conditions, he said.

"Let's take a common sense, evidence-based approach," Lemstra said. "Buy 12 million masks. Reopen society."

Not a return to "business as usual"

The coronavirus has caused untold damage. But Camillo, Lewis and others say it gives society a chance to re-evaluate, and eventually start over. What is essential? What is healthy?

For Camillo, that means preparing better for the next pandemic — more surveillance, more research, more reserve supplies.

But it goes far beyond the medical system. Camillo says Saskatchewan needs to improve its social determinants of health, and consider elements like reconciliation and growing wealth inequality.

Even climate change is part of that broader definition of health, Camillo said. She noted air pollution levels are down in many places since the COVID-19 imposed travel bans and economic slowdown took effect.

She pointed to a new Harvard School of Public Health research paper showing higher COVID-19 death rates in U.S. counties with higher air pollution.

"All of this should be a vision of what our community needs to look like to be healthy," she said.

Lewis agreed. He said the pandemic's devastating effect on the fossil fuel industry, for example, could accelerate development of renewable energy sources and jobs.

"What can we do to solve some longstanding problems we've taken too lightly in the past?" Lewis said.

"I think this could be the occasion for a bit of a reset. Out of this tragedy may come some long-term good."