New 'near zero' COVID approach needed in Canada, argues group of academics

In early May 2020, when the B.C. government announced its COVID-19 recovery plan, senior health officials were clear about their strategy. 

Eliminating transmission of the virus was seen as an impossible goal because of the size of the province and its physical links with Washington state and Alberta. Instead, B.C. would seek to contain the virus, removing or adding restrictions as case counts fell or rose, until a vaccine was widely distributed. 

That was roughly the model in all parts of Canada outside the Atlantic bubble and the vast majority of jurisdictions in North America and Europe. 

Nearly all those countries, states and provinces are now struggling to contain the virus, regardless of their success in the spring and summer. It's led a group of Canadian academics and business leaders to argue there's one final opportunity for a new approach. 

"We know that what we're doing isn't working. We need a strategic way forward," said Caroline Colijn, an infectious diseases specialist at Simon Fraser University and member of a new initiative called COVID Strategic Choices. 

"We have to do something else in the meantime, because we have six months or maybe more before we can rely on the vaccine to support our social and economic activity."

Clear metrics, greater restrictions, tracking travel

Colijn's group is advocating for a "Canadian Shield" strategy, one where all provinces commit to the same general strategy, with strong restrictions over the next four to six weeks. 

The goal wouldn't be "COVID zero," referring to countries that have aimed for complete elimination of the virus, but COVID "near zero."

The approach would involve a four to six week lockdown to reduce the virus to a point where testing and contact tracing can be a sustainable strategy until vaccinations are readily available. Following the lockdown, it would involve setting clear goals with set numbers defining success or lack of it, expanding and lengthening restrictions where necessary.

Examples of possible new restrictions would be closing gyms and high-density retail outlets, public health orders against travel instead of recommendations, and high school and post-secondary school closures.

Without serious changes, COVID Strategic Choices believes it will be difficult to dramatically reduce transmission.  

"Every place has learned. They've all gone 'look what happened to our contact tracers. Oh, now they're delayed. Oh, now they're overrun,'" said Colijn.

"Then we have to close down again. And I think we've seen this multiple times."

Colijn and other researchers looked at a grouping called TAZNAC democracies — referring to Taiwan, Australia, New Zealand, and Atlantic and Northern Canada — and found that all have seen better economic outcomes (measured by 2020 GDP projections), in addition to their low case counts. 

"There's been this framing of it's the economy versus COVID," she said," [but] controlling COVID and then reopening and being able to sustain a reopening would actually be better for the economy, as well as for health." 

Can everyone be on the same page?

Colijn acknowledges there are several obstacles to the Canadian Shield plan. One is getting all provinces between B.C. and Quebec to agree to the same general plan. Another is getting buy-in from the public for several more weeks of large restrictions when some people are already getting vaccinated.

But she argues we've seen what the alternative is — and it's not worth repeating in 2021. 

"It's becoming clear how bad it is to keep telling everybody to shut down and have these extreme distancing measures, and then have them relax for a little bit, and then have to roll them out again," she said.

As most Canadians begin a new year with an old strategy, Colijn is hopeful alternatives will be considered. 

"Whatever we do for a few weeks, it's a one-off measure. And when we stop doing it, we get back to where we were before," she said.

"We need to do something else."