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The key metric that will tell us if Canada is headed for a U.S.-style COVID-19 crisis – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


A recurring fear looms over newly reopened bars and restaurants, lurking over crowded aisles, clinking glasses and face-to-face banter enlivened by alcohol.

Are we sleepwalking toward an American-style coronavirus crisis?

As Canadian establishments reopen, it’s a worry voiced even by some people with a financial stake in the hospitality business. 

Two Montreal restaurateurs said they were aghast at behaviour they witnessed after businesses resumed operating several weeks ago.

“Frustrated. Angry. Disheartened,” is how Stephen Leslie, owner of Tavern on the Square and Monkland Tavern, describes his reaction to seeing other establishments defy safety guidelines, with too many tables and too little PPE for staff.

“You just can’t help but think that what’s going on to the south of us — Texas, Florida — how they’ve been forced to re-close is going to happen to us here if we don’t follow the rules.”

A patron enjoys a glass of wine at the bar of Lemeac restaurant on the first day after restrictions were lifted on restaurants in Montreal, on June 22. (Christinne Muschi/Reuters)

Ilene Polansky, owner of Montreal restaurant Maestro SVP, said disrespectful clients littered; stumbled into her; did not distance; refused to wash their hands; and stormed off when she declined to group tables together.

“They said, ‘One-star review for you. We’re never coming [back] here,'” Polansky recalled. 

“It’s sad that I have to tell people to follow the rules.”

Now Montreal has long lineups for testing, with infections rising and dozens of cases linked to bars, prompting new provincial guidelines

Alberta faced 41 new cases tied to outbreaks at four restaurants in Edmonton late last month. British Columbia has seen exposure to COVID-19 in bars, nightclubs and strip clubs since reopening. Ontario reopened bars and restaurants in much of the province Friday as it moves into Stage 3

The post-reopening spikes inevitably raise questions about whether Canada is simply a few weeks behind a neighbour that reopened sooner.

In the U.S., a new wave of the virus is battering virtually every region, with cases rising in most states; record spikes in several of them; and hospital bed shortages in Florida and elsewhere

To gauge whether the early signs in Canada point to a scenario similar to the one flaring up through the U.S., CBC News consulted three infectious disease experts, four public health officials, and national, state and provincial data.

One of Canada’s best-known public health experts said she lost sleep over the decision to reopen bars in B.C. — but she’s now confident in their ability to clamp down on outbreaks quickly before they spiral out of control. 

“We’ve had our restaurants and bars open for the last month now, and we haven’t had major outbreaks,” Bonnie Henry said in an interview with CBC News. “It’s not been perfect, and we’ve had to revise things.”

Henry said B.C. reopened establishments in a “manageable” way that allowed people to socialize safely, with smaller capacities, strict physical distancing and hygiene protocols, and a COVID-19 safety plan in place

“The first thing people said when we had the exposure event in a couple of the nightclubs in Vancouver was, ‘Oh, shut them down.’ But that doesn’t help,” she said, adding officials worked with the industry to minimize risk to patrons and staff.

“It just drives people underground, where we won’t hear about cases because they’re afraid to talk about it.”

‘You can’t eat and drink with a mask on’

When trouble hit the United States, it initially struck with stealth — as a series of anecdotes, unheeded warnings, contradictory news headlines, and videos of safety guidelines being ignored.

Within days the headlines took an unambiguously bleaker turn. Arizona reported its highest one-day increase in cases. Then the cases kept growing, and growing, then doubling, tripling, quadrupling

California is among the many states experiencing a surge in coronavirus cases. Pictured are cars lined up at a drive-thru testing site at Dodger Stadium in Los Angeles on Thursday. (Lucy Nicholson/Reuters)

Now Canada is also reopening what experts describe as some of the highest-risk environments — bars and restaurants.

People are indoors, in close contact, sharing food and drinking while proven infection-control measures — like physical distancing, hand hygiene and mask wearing — are also much harder to maintain.

“You can’t eat and drink with a mask on,” said Dr. Matthew Oughton, an infectious disease specialist at the Jewish General Hospital and an assistant professor at McGill University in Montreal.  

The spread of COVID-19 among bar-goers who aren’t displaying symptoms is another major risk factor.

“The risk is that you could be feeling totally fine and ready to go for a night out,” he said. “And your dining partner might be infected, or you might be infected and yet not know it.” 

Oughton said the biggest challenge for public health officials is catching those outbreaks from bars and restaurants early enough to stop them from “snowballing” into larger threats to the community. 

He said they need to focus on isolating positive cases and contact tracing to ensure the virus doesn’t spread in the community unchecked after an outbreak. 

“We are sitting in a forest that is bone-dry and there are lots of places where sparks might flare up,” Oughton said.

“So you can stomp out the first spark, you can stomp it the second spark, what worries me is if there’s 100 different sparks starting 100 small brush fires, can you actually stomp it all of them in time?”

WATCH | B.C. and Quebec hurry to trace new COVID-19 clusters

Authorities in B.C. and Quebec are racing to contain a new cluster of COVID-19 cases linked to bars and social gatherings. 2:04

But the statistic to watch, according to one U.S. epidemiologist: the percentage of people testing positive for coronavirus, and which direction it goes.

That’s a metric Jennifer Nuzzo follows closely as a leading indicator of where case totals are headed.

If it starts to move down, that’s good news; if it moves up, that’s a red flag that more cases are being missed, more people are unwittingly spreading the virus, and there’s a growing chance it might spiral out of control. 

“I pay a lot of attention to positivity,” said Nuzzo, an epidemiologist at Johns Hopkins Bloomberg School of Public Health.

“If it starts to pick up, that’s, I think, a worrisome development.”

The goal set by the World Health Organization is to keep positive test rates below five per cent.

By that standard, the U.S. is in brutal shape. A whopping 33 U.S. states had rates higher than the WHO benchmark on Thursday, with several just above or just under 20 per cent.

Canada has far lower positivity rate than U.S. 

That’s exhibit A in the difference between Canada and the U.S..

U.S. states were indisputably in worse shape when they reopened indoor social establishments: 

Arizona’s positivity rate was around six per cent when it allowed restaurants and some bars to reopen on May 11 — and has surged to a recent peak of 26.9 per cent, according to figures compiled by Johns Hopkins. The Texas rate hovered above five per cent this spring during the weeks it reopened, and is now at 16 per cent. Florida reopened restaurants in most places on May 4 and bars on June 5, a period during which test-positivity rates were between two and five per cent — and then started surging to a peak near 20 per cent.

( )

Canada is simply not in that ballpark. 

In Montreal, even after its latest spike, the positivity rate inched upward, from a low under one per cent to three per cent this week. Quebec overall has a positivity rate of 1.4 per cent; British Columbia and Ontario both sit at about 0.8 per cent positivity; and Alberta hovers around 1.7 per cent

More than 3.3 million Canadians have been tested for coronavirus since the pandemic began, with a positivity rate of about three per cent.

( )

U.S. states reopened with little regard for such metrics, said Dr. Abraar Karan, a physician and public health researcher at Harvard Medical School who is aiding the Massachusetts pandemic response. 

He said the U.S. could have avoided a spike in cases from reopening if it had simply taken its own advice: in May, the U.S. Centers for Disease Control and the White House published careful step-by-step guides to reopening based on scientific benchmarks.

“The thing is, none of those were actually implemented at the state level across the United States,” Karan said.

Right after the White House published those guidelines, however, the president of the United States was essentially brushing them off, calling on states to reopen in a series of all-caps tweets like, LIBERATE MICHIGAN!” 

That illustrates another difference between the countries: politics.

Canada has not had as vocal a chorus of coronavirus-doubters in its media and political establishments

Bar patrons attended a reopen-Florida maskless rally and dinner in Windermere, Florida, this week, illustrating the political debate over pandemic precautions even as cases surge in the U.S. (Octavio Jones/Reuters)

Attempts to lock down the U.S. have prompted armed protests; numerous lawsuits; and open defiance of efforts to shut down bars.

Even now, the governor of Georgia is preventing cities from imposing masks. 

And while the numbers are shifting, as the U.S. grapples with this ongoing wave, data collected by Google from people’s smartphones showed Canadians doing far more physical distancing than Americans in the winter and spring.

“What happened in the States is that they did a fast reopening, before they even came close to settling down their first wave. So what’s going on now is not a second wave, it’s a continuation of the first wave,” Oughton said. 

“Whereas it’s very safe to say that in Quebec — and, in fact, across Canada — we really have largely controlled it.” 


To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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COVID-19 case investigations continue to lag days behind case identification in Manitoba – CBC.ca

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COVID-19 case investigations in Winnipeg are lagging days behind positive test results, contrary to the premier’s claim Manitoba has no more contact-tracing delays.

On Friday, Premier Brian Pallister said tracing delays are a thing of the past in this province.

“There’s zero backlogs on tracking and tracing right now in our province,” Pallister said during an interview that aired on Rosemary Barton Live on Sunday.

Backlogs, however, remain. CBC News has learned public health nurses in the Winnipeg health region started investigating COVID-19 cases on Monday that were identified as positive on Nov. 19 — a delay of four days — and are still working overtime to catch up on caseloads.

This four-day delay represents a vast improvement from October, when COVID-19 patients reported contact-tracing investigations lagging behind positive test results by as much as a week.

It nonetheless remains well behind the 24-hour timeframe epidemiologists have recommended for starting contact-tracing investigations in order to limit the spread of COVID-19.

“A twenty-four hour delay in getting a hold of somebody in a shelter, that’s a disaster,” said a public health nurse who CBC News is not identifying due to fears of repercussions.

WATCH | Manitoba Premier Brian Pallister insists his province’s restrictions are the most stringent in the country:

Delays are particularly important to avoid in Winnipeg, where people living in homeless shelters are disproportionately affected by the pandemic, the nurse said.

“When you get somebody on the phone that’s living on the street and you’re telling them they have COVID, it’s a lot different than calling somebody who’s living at home and have three people in their house.”

Darlene Jackson, president of the Manitoba Nurses Union, said the four-day lag reported by the public health nurse is in line with what she’s hearing from her members. 

“We’re hearing that there is a lag — anywhere from a couple of days, to five days,” said Jackson, adding some public health nurses are required to work evenings and weekends in order to catch up on caseloads.

“We know that public health nurses are still working excessive amounts of overtime. They’re being mandated frequently. They’re working through weekends. They’re not allowed to go home until they finish contact tracing on cases. It’s been it’s been months like this, with no end in sight,” Jackson said.

“I just find it very frustrating. We’re already eight months into a pandemic and it just feels like we’re just trying to get caught up now.”

Dr. Brent Roussin, Manitoba’s chief provincial public health officer, made it clear on Monday the lag involves the time between the identification of a positive case in a laboratory and the handover of information about that case to public health.

“Almost all cases are reached within 24 hours of the report being reported to public health,” said Roussin, adding some case investigations do not begin until the next day after that.

Province adding contact tracers

Case investigations are one aspect of contact-tracing in Manitoba. The province employs an average of 170 people per day — public health nurses and contractors with the Canadian Red Cross — to conduct these investigations.

The province also pays for an average of 80 people a day to notify contacts of known COVID-19 cases. Statistics Canada has been enlisted for this task.

The third aspect of contact tracing involves follow-up calls to infected patients. These are conducted by 43 staff and volunteers at the COVID-19 Contact Centre, jointly run out of the Deer Lodge Centre by Shared Health and the Winnipeg Regional Health Authority.

Dr. Brent Roussin, Manitoba chief public health officer, said most case investigations begin within a day of public health learning about them. (John Woods/The Canadian Press)

On Monday, Health Minister Cameron Friesen promised to bolster these 203 positions with 143 more workers.

The public health nurse who spoke to CBC News said that won’t help unless the reinforcements have specialized training.

“We need people who have the knowledge and the education to do proper contact-case investigations. It’s more than just calling people and telling them they have COVID,” the nurse said.

“We’re doing health assessments and directing people where to go if their symptoms exacerbate. We’re dealing with people who are structurally disadvantaged, who don’t have home. I mean, those are things that public health nurses know, not somebody answering the phone at a call centre.”

Contact tracers not allowed to work from home

The Manitoba Nurses Union also chastised the Winnipeg Regional Health Authority for not allowing COVID-19 case investigators to work from home.

Public health nurses are being subjected to unnecessary risks at the office — while some are unable to work because they are sick, isolating or caring for children, the union said.

“I do not understand why public health nurses are not allowed to access their files that they need at home and to work from home,” Jackson said.

Roussin, who has urged all employers to allow employees to work remotely, encouraged the WRHA to consider doing the same.

“If you can make it feasible, if you can get the work done by being at home, then I would encourage all employers to to look at that,” he said.

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Confusion remains in B.C. on who can gather in restaurants under COVID-19 restrictions – Global News

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The B.C. Restaurant and Food Association says a new set of COVID-19 restrictions imposed by the provincial government has customers struggling to understand who they are allowed to dine with.

The association’s president Ian Tostenson says restaurants are trying to tell customers to use common sense and follow advice from provincial health officer Dr. Bonnie Henry, but he says that advice has been unclear.

“There is a lot of confusion as to who can dine out as a result of the last couple of weeks with Dr. Henry,” Tostenson said Monday.

“The spirit of what Dr. Henry is saying is eat with people you trust, eat with people in your bubble. But if you try to define that too much it gets too hard.”

Read more:
‘Kicked when we’re down’: New COVID-19 restrictions hit already struggling B.C. restaurants

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The provincial orders issued last week require diners to only eat with someone from their own household. If someone is single, they can eat with one or two other people who make up their pandemic bubble.

[ Sign up for our Health IQ newsletter for the latest coronavirus updates ]

For example, three friends who are also married cannot all eat together at a restaurant. Another common mistake is parents cannot take their adult child and spouse for a meal at a restaurant if they live in separate households.

“For these two weeks we’re saying stick with your household bubble, and for some people that may mean one or two people who they have close contact with their pandemic bubble,” Henry said Monday.

The biggest challenge to uphold the order is enforcement.

Restaurants are being told not to ask diners whether they are following the rules. Instead, Henry is asking diners to know the rules themselves.


Click to play video 'Christmas events put ‘on hold’ by pandemic'



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Christmas events put ‘on hold’ by pandemic


Christmas events put ‘on hold’ by pandemic

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“It is not the restaurant’s responsibility to ask people who they live with, or where they are from,” Tostenson said.

“The more that we increase confusion and uncertainty in the marketplace the harder it is.”

There is growing concern from the province that British Columbians are trying to exploit loopholes in the order. The priority for the government is to crack down of social gatherings if that is in someone’s home or in a restaurant.

Read more:
Your questions about B.C.’s new COVID-19 measures answered

One thing enforcement can do is crack down on organized events in a restaurant like live music.

“There is a tendency to … see these like a speed limit and it says 80 (km/h), and maybe I can go 86. That’s not what these are,” Health Minister Adrian Dix said Monday.

“These are provincial health orders to help us stop the spread of a virus that is harming our loved ones in long-term care and causing great disruption in our society, and these are the things we’re doing together to stop that.”

© 2020 Global News, a division of Corus Entertainment Inc.

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'We are on the verge of significant bankruptcies': Restaurants and pubs struggle under B.C.'s new restrictions – CTV News Vancouver

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VANCOUVER —
New measures introduced last Thursday by Dr. Bonnie Henry meant to curb the spread of COVID-19 by limiting social interactions appear to be having the desired effect, to the detriment of businesses.

At a news conference on Nov. 19, Henry ordered B.C. residents to limit social gatherings to their immediate household, or a small pandemic bubble for those living alone.

“This applies in our homes, vacation rentals and in the community and in public venues, including those with less than 50 people in controlled settings,” Henry said.

She made no specific mention of restaurants or pubs, and Ian Tostenson with the BC Restaurant and Foodservices Association said there has been confusion about who can dine out.

“We haven’t seen the latest health order, it hasn’t been written from last week, so as far as we’re concerned, we’re telling people go to a restaurant but go to a restaurant in the spirit of hanging with people you trust in a small bubble,” Tostenson said.

Tostenson estimates over the last 10 days, restaurants have lost about 30-40 per cent of their pandemic sales as those who were confused by the orders chose to stay home.

Henry’s order was an expansion of a previous regional order that only applied in B.C.’s Lower Mainland. During prior news conferences, Henry made clear that while dining out was encouraged, people should only do it with their households.

On Monday, Henry clarified again that she wants British Columbians to spend the next two weeks only socializing in person with others from their household, or a bubble of one or two designated people for those who live alone. That applies to going to restaurants.

The restrictions are also hitting bars and pubs hard. Jeff Guignard with the Alliance of Beverage Licensees estimated business dropped by 50 per cent of pandemic levels.

“So you have people who are down to 25 per cent of where they were in 2019 and that’s just not sustainable. We’re on the verge of significant bankruptcies right now,” he said.

Restrictions are scheduled tin place until Dec. 7.

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