COVID-19: Why reacting early and aggressively is the key to avoiding crisis

It has been a week of dramatic developments as the world responds to the COVID-19 pandemic.

Events are getting cancelled at a furious pace — everything from the NHL and NBA season to the Juno awards. Schools are being closed, public meetings postponed.  And our Prime Minister is in self-isolation.

Authorities are moving fast, and whether they're moving as fast as the virus, remains to be seen. But just how effective is this social distancing, and what are we learning from other countries?

Dr. David Fisman is an infectious disease physician and professor of epidemiology at the University of Toronto's Dalla Lana School of Public Health. Here is part of his conversation with Quirks & Quarks host Bob McDonald.

This interview was recorded on Thursday evening before President Trump declared a national emergency on Friday. It has been edited for clarity and length.

So given what we know about the pandemic right now, do you think the responses we've seen — with the cancellation of events like the Juno Awards or the suspension of the NBA, the NHL season, closing schools and all these other actions — are they appropriate?

They're highly appropriate. We have to be proactive, rather than reactive. I'm delighted that Ontario has decided to have an extended, a three week March break to allow kids to come back from the US a good 14 days extra after they come back, to stay at home in case they have any symptoms of COVID after returning from Florida. And I think it's exactly the right thing to do.

I think we need to do it for the sake of vulnerable folks in our society and I'm delighted to see us do it proactively rather than reactively in a time of crisis.

If we allow this to get bad, it gets bad fast, and it gets horrible fast. And that's why we have to be proactive.- Dr. David Fisman

What do you say to people who say, well, you know, a lot more people die from the flu every year and we get the flu every year and we don't react that way. We're just over-hyped and scared?

Yeah, the case fatality of this thing is probably about 20 times that of influenza. Any clinician will tell you that in a bad influenza year our hospitals are filled to the bursting. There's a logjam, our ICUs are full. Our emergency rooms are full. People wind up basically boarding in the emergency rooms because all the beds in the hospital are full. That's a bad flu year. This is 20 times worse.

So the idea is for this not to be bad. And that's why we have to intervene so strongly.

We're fundamentally a discipline that's about prevention and having our actions result in non-occurrence of events. And I'm entirely comfortable with folks criticizing this and saying, look you cancelled our concerts, you cancelled the NHL season, you terrible person, you made restaurants empty out for a month and then nothing happened. That's the point. By doing that we make nothing happen for a little while until this starts to heat up again.

If we allow this to get bad, it gets bad fast, and it gets horrible fast. And that's why we have to be proactive.

Well when it comes to other countries, which ones are dealing with it well, and which ones are dealing with it badly?

So, Italy is having a terrible time. There's not enough kind of ICU beds and machinery to save the lives of people who go into respiratory failure. So people are now dying in Italy without care, because the hospitals are full to the bursting.

We're following the example of the countries that have done well.- Dr. David Fisman

By contrast I think at this point, we can look at Singapore, we can look at Hong Kong, at places that have intervened early and aggressively before things became quite as dire, and seemed to have quashed local transmission quite quickly using fairly dramatic social distancing measures. But that's allowed them to kind of move on and get back to business.

That's why I think the decisions that are being made in Canada this week about proactively enacting social distancing measures are so important. We're following the example of the countries that have done well.

Are there indications from countries like China that it's possible to get this epidemic under control and maybe even stop it?

Absolutely. And the Chinese took a massive epidemic which was very large at the time [before] they even identified what was going on, they turned the tide and they appear to have a minimal number of new cases at this point. So that that was a Herculean task.

What we see historically and what we're seeing with this in in Wuhan, what we're seeing with this in Daegu and South Korea right now, what I think we're starting to see in Italy as well, thank God, what we're seeing is that [...] you don't have to wait until half the population are immune for the epidemic to peak and turn. People adapt in different ways. We get frightened, we distance ourselves from one another naturally. We come up with good ideas about how the disease might be spread and we implement them.

The difficulty in Italy is they're doing that and they're bending this curve, but because of the pace of this disease and the high likelihood that it causes respiratory failure, particularly in older people who get it, by the time you're bending that curve you have saturated your hospital capacity, and people are starting to die because you can't care for them you can't offer them anything.

So that's the tragedy of COVID. If you wait until it's a crisis and then say we're going to respond to this crisis by implementing drastic public health measures, they will work, they will work predictably, but you've already missed the boat, because the time to intervene was before it got bad because you knew it was going to get bad, you knew that when it was quiet was the time for you to intervene.

So that's why I'm so delighted to see what Ontario and other provinces are starting to do this week.

I think there are a lot of blind spots in the United States.... It's not just a problem for the Americans, it's a problem for us too, because we'll import those cases.- Dr. David Fisman

The last time you were on our program you were particularly concerned about the situation in the U.S. and how they're dealing with COVID-19. What's your take on that now?

You know the United States to me actually represents a little bit of a tragedy. You have a country that has, in the CDC, probably the best public health institution on the planet. And you see it hamstrung by a federal executive branch. What that results in is basically a decapitated public health system.

And what you see is that states that have strong public health systems, and strong public health institutions, of necessity, those state institutions are kind of rising to the occasion and doing the job. And I think it's no coincidence that the hot spots in the United States, the perceived hot spots right now, are the places that have strong state level public health institutions, because those state level public health institutions are able to do the surveillance when the federal authorities have sort of dropped the ball.

What I really worry about in the United States is you have tremendous variability between states in terms of the strength of public health institutions. We have a situation in Nevada for example where last week there were three Nevada linked cases reported in total. Two of them were in Las Vegas and the third one was in a Canadian who had just returned from Las Vegas. That means there is a big epidemic there because most people aren't on a given day getting on an airplane. So if you're exporting cases it means prevalence is high.

So I worry about those quiet places in the U.S. I worry about Florida where apparently testing capacity is very limited. And I think you have a large concentration of individuals in the age groups that get very, very sick from this virus. So I think there are a lot of blind spots in the United States. It's a very big, very heterogeneous country and it lacks effective public health leadership right now. It's not just a problem for the Americans, it's a problem for us too because we'll import those cases. 
 

I think we have to realize that ... clustering together in large groups in small spaces is a bad idea for right now.- Dr. David Fisman

I do think that it's a reasonable moment, given the prominence that kind of large gatherings have had in the history of this epidemic so far, I think we have to realize that clustering together, given the cruise ship outbreaks, clustering together in large groups in small spaces, is a bad idea for right now.

I think it's a golden moment for us to embrace a lot of the technology we have, where we can communicate and conference and share information without sharing viruses. And I think this is the moment, really, to use those.

Produced by Sonya Buyting and Jim Lebans. Written by Amanda Buckiewicz.