Shockproofing Canada: Here's what it will take to reopen the economy – Financial Post

Canada needs to become more secure by becoming more self-sufficient. In a new series — Strong & Free: Shockproofing Canada — the Post examines how a country made wealthy by globalization and trade can also protect itself against pandemics and other unknown future shocks to ensure some of our immense resources and economic power are reserved for our own security.

Canada is in for a “long fight” to reopen its economy, one requiring not just a massive increase in testing for COVID-19 but also a significant overhaul in the way infectious disease data is collected and shared among provinces, epidemiologists say.

Though recent data suggests Canada has had success in flattening the curve of coronavirus cases, infectious disease experts are warning against seeing the numbers as a sign that the fight against the virus is over — or that the country has the necessary tools in place to reopen businesses without prompting a renewed flare up of the virus.

“Bending the curve in principle simply slows the intensity of people getting sick such that you don’t overwhelm the hospitals, that’s all it does,” said Dr. Barry Bloom, a professor of public health at Harvard University, specializing in infectious diseases.

“Everybody locked up who has not tested positive is still susceptible. The virus looks for susceptibles and the only way the epidemic stops is when there aren’t enough of them to sustain it. So the question is, how do you let people out once you’ve protected the hospitals and how do you know when you’ve gone too far?”

Getting it wrong could have devastating consequences for an already staggering economy. Most forecasts call for growth to hit a low point in April or May at which point it will stabilize or slowly recover. A second wave of COVID-19 cases could create a confidence shock to consumers that would derail those predictions, said Frances Donald, chief economist at Manulife Investment Management.

“What worries me is that crawling out of this economic hole is already going to be extremely challenging,” Donald said. “We are worried about the rise in defaults and delinquencies among businesses and households. And every time we shutter the economy we risk another wave of defaults.”

Getting an economic restart right, most experts agree, will overwhelmingly rely on the hard work of testing, contact tracing and sharing data, critical tasks that run the risk of being hindered by supply chain bottlenecks, a lack of consistency in testing protocols among provinces, poor data sharing and difficulties presented by the disease itself.

“You need very quick, very large scale testing in place before you do anything,” said Amir Attaran, a professor of law and epidemiology at the University of Ottawa. “If you don’t have that in place, forget about it.”

Part of the challenge comes down to the highly contagious nature of the virus itself. In the early days of the pandemic, testing was limited in various ways across the provinces to vulnerable individuals, those who had travelled to COVID-19 hotspots and, crucially, to those with symptoms.

However, early evidence from countries that have engaged in widespread testing shows that between 25 and 50 per cent of those infected with COVID 19 do not display any of its telltale signs — including a cough, a fever, shortness of breath and runny nose. And as international examples suggest, “if you don’t identify people who are asymptomatic transmitters it will flare up again,” said Bloom.

As evidence of just how potent asymptomatic spread can be, Bloom points to a February meeting of 175 executives of the American biotechnology company Biogen Inc. in Boston. Two weeks after the gathering, which included at least one asymptomatic individual, 75 per cent of the 108 Massachusetts residents infected with COVID-19 were associated with Biogen.

“Any percentage of the population that is asymptomatic but infected and allowed back to work has a good shot within a two week period of infecting those they come into contact with,” Bloom said. “The only way to know if they will is by testing and that means testing a hell of a lot of people.”

How many? Ontario, with a population of 14.5 million has tested 94,000 people with plans to double the number of tests processed each day from a current 4000 to 14,000 by April 29, 2020 — at which point it says overall lab capacity will have been further expanded. Iceland, by contrast, has already tested 100,000 of its 364,000 residents. Norway is running 30 tests per 1,000 of its population — roughly double that of Ontario.

“No one knows how many you need, certainly millions,” Bloom said. “You need as many as it takes to get the rate of infection down and keep it down. I’ll tell you the United States will never have enough so just start making them.”

Efforts to ramp up testing have almost immediately run into what has now become a hallmark of the pandemic: shortages of critical medical equipment and devices due to supply chain issues.

COVID-19 testing involves the use of six-inch nasopharyngeal medical swabs, the vast majority of which are produced by just two companies: Copan, an Italian firm, and Maine-based Puritan Medical Products, said Fazila Seker, president and chief executive of Toronto based Molli Surgical Inc.

“There is a massive shortage because there is unprecedented need,” said Seker, whose company has partnered with automotive manufacturers NMC Dynaplas Ltd. to produce the swabs in Canada. “Every week there is a different bottleneck and that’s because the scale of need is so massive.”

Using open source design information from researchers at Harvard University and Beth Israel Hospital, Molli Surgical expects to produce one million swabs by July 1, with production ramping up to 500,000 per week after that.

Beyond producing equipment however, a responsible approach to reopening the economy will depend on straightening out testing discrepancies among provinces and bolstering data collection to inform policy, Attaran says.

Though the federal government collaborates with the provinces on testing, critical decisions about who is tested, how the data is gathered and what is shared —  including critical “microdata” about patients ages and how many end up in ICUs  —  sits at the provincial level.

Every week there is a different bottleneck and that’s because the scale of need is so massive

Fazila Seker

For instance, while Alberta has made testing available to anyone exhibiting symptoms of COVID-19, Ontario has limited it to people sick enough to be in hospital, health-care workers, long-term care residents and Indigenous people. Manitoba and Quebec have similarly established their own procedures for administering tests.

Without a single baseline for who is tested, how many tests are administered per 100,000 population and how the data is reported to the federal government, no accurate national picture of the virus’s spread is possible, said Attaran.

“We’re comparing apples and oranges and that limits the uses to which you can put data,” he said. “It limits the scientific questions you can reasonably answer and the decisions you can make. That’s really too bad given what we’re dealing with.”

Financial Post

• Email: npowell@nationalpost.com | Twitter: naomi_powell