Coronavirus Ontario Long Tail & Reopening Thoughts

Lots of people are talking now about when and how we’re going to be able to unlock and get “back to normal”, so I figured I’d join that chorus.

Lots of people are talking now about when and how we’re going to be able to unlock and get “back to normal”, so I figured I’d join that chorus.  Some interesting links first:

In my previous post, I predicted Ontario would end this phase mid-May with between 8-12k cases. Sadly, in the last few days, we HAVE NOT seen the kinds of declines in numbers of new infections that I was hoping for. Here’s a table of how it’s been going:

Basically, we’re looking at a decline here more like they have in Italy than they have in BC (or Australia, or Korea, etc), and that means that (a) it’ll take a lot longer to get to a place where we can open up and (b) we’ll end with a far higher number of cases.You can see that it’s been basically flat in terms of the number of new cases per day, with the “peak” such as it is on Apr 8th, itself several days later than I would have predicted based on our lockdown date. And recently it hasn’t even been declining in percentage terms, let alone absolute, which is terrible.

Why is our tail longer? I think it’s basically two reasons: (1) our testing has been somewhat crappy, so some of the cases we’re reporting now actually come from earlier, i.e. our peak is actually larger than it looks (this crappy testing is also evidenced by our fairly high case fatality rate, currently at 4.6%) and (2) our lockdown has sucked, in the first week we didn’t properly close most businesses in Ontario, and even now, our social distancing isn’t great (I can see how crappy it is in Trinity Bellwoods Park, and also at the local Metro).  I think we ARE getting better over time, e.g. with actual proper PPE on the staff at Metro now, and more people taking the distancing seriously, but it’s taken way too long to get here, and we’re seeing that in an extended flat period in the cases, rather than a decline as we all hoped to see by now. I think we WILL see it start to decline eventually (hopefully in a few more days, once we work through the testing backlog again), but it’s clear that we’re in for a lot more cases than a quick decline (like happened in BC) would have predicted.

Anyway, the net-net is, my prediction now is that we’re going to need to stay locked down until the end of May, and that we’re likely to have 15-20k cases by then.

Beyond the end of May, a few Reopening thoughts:

  • We’re going to need to massive amounts of PPE in order to open up. Especially here in Toronto, I feel like everyone who wants to ride the TTC is going to have to properly wear a mask. Because it’s just not possible to socially distance on a bus, streetcar, or subway when it’s even half full, let alone at rush hour. So if we’re going to go back to even half of the people commuting to work, those people are going to have to wear PPE, there just isn’t any way around it. That in turn implies that we CAN’T open up until literally tens of millions of masks are available in Toronto, and obviously that isn’t going to be true for a long while… Here it is in the news, just moments ago: New York Orders Residents to Wear Masks in Public.
  • Supporting the above, we have to continue to socially distance, because we’re not going to be able to keep the number of cases at zero. We border New York State, the most infected place in the world, and even just essential travel and goods to and from there are going to give us a certain amount of unavoidable exposure to active cases, even assuming that NY gets their own epidemic under control (they did seem to be doing OK, but numbers today had them shooting back up again, so it’s a bit hard to tell!).
  • We’re going to have to keep travel bans / border closures in place to lots of parts of the world, and also, make sure that people are not just connecting via some third place in order to hide their origins from places that are still heavily infected. Trudeau announced recently that travelers now need to have a “credible plan” for how they will self-isolate (rather than just promising that they will do so), I hope this actually gets more strict, for countries of origin that have current epidemics
  • We also need to really get our shit in order on testing and contract tracing. I feel like I’m actually echoing Doug Ford here, which is creeping me out a bit, but it’s true – the foundation of “the dance” is the ability to rapidly identify cases, and isolate all of their recent contacts until such a time as they too can be tested (recent infections don’t actually show, you need to wait two-three days before the virus breeds enough to be detectable).  Apple and Google partner on COVID-19 contact tracing technology – is actually a privacy respecting way to do it, but I’m hugely skeptical that it’ll get enough adoption to actually be useful. I think we’re going to have to rely on old-fashioned contact tracing via interviews and sheer man-power. I read that China built up 1800 teams of 5 people each to do contact tracing in Wuhan – we won’t need that many once we’ve got this under control, but I still think Ontario as a whole will need scores of such teams for the foreseeable future, and it’ll be similar in all provinces.  This is perhaps a job for the Canadian Military? It’s gonna require some dedication (read: monotony, doing the same thing over and over), and considerable attention to detail, and some authority (“please tell me everything about your life for the last week, sir”), so I think military personnel are pretty well suited to it.
  • Libraries and Museums, e.g. the science centre, are probably going to have to really restrict capacities. Those kinds of “crossing grounds” where lots of people who would otherwise never interact potentially spend hours in each others presence are the worst kind of super spreader things, other than large scale events like festivals. Perhaps they will even have to stay closed, but I hope it’s workable to open them with very low capacity limits, i.e. literally a guard at the door who makes sure that there are no more than X people inside, where X is probably 1/20th or less of the usual fire capacity. It’ll give those places a totally different kind of vibe too, and it’s not clear that it’d even be economic for e.g. the ROM to be open. With ticket sales forced to be that low, it is worth having the staff keep the place open? So much will have to be figured out.
  • On a sort of similar front, I’ve been thinking about elevators. It’s clearly a bad situation, especially in a lot of the new condo buildings, where I know that rush hour often sees the elevators (and lobbies) be worse than the subways in terms of crowding. Is even good PPE sufficient in such a confined, stagnant air situation? Maybe we require lots of people to climb stairs? That’s obviously not super practical above about 20 stories, but SOMETHING needs to be done. Heck it’s probably bad even now, with lots of people staying home (i.e. do you get in an elevator if there is already another person in it?), but it’ll be just impossible once we open up… I’m glad to live in a house in a fairy low density (for downtown Toronto) area, that’s for sure.
  • Plus all the things I mentioned in the last post – no large gatherings, restrictions on density at restaurants, continued working from home by whoever can do so, special measures at schools and other dense places.
  • All these types of restrictions will hopefully be able to be released slowly, as the number of new cases, and the danger from travelers, etc, gets lower over time. But that’s ONLY true if we avoid another epidemic. If cases go up again, and reach another epidemic, we’ll have to do this whole thing all over again, and obviously nobody wants that… that’s the number one reason why we can’t open up anytime soon. We need to start from a super low number (ideally zero, but that’s not practical), so that we have good odds of just keeping it down using testing and contact tracing/isolation, rather than doing this all again in Aug/Sept/etc…