Jonathan Kay: The second wave will be different ... because we're different, now
Even as cases surge in parts of Canada, the many changes in our behaviour since the spring will help avoid another catastrophe.
By Jonathan Kay
To start things off, a practical tip. If you go for COVID-19 testing, bring a folding chair, a book and food. My family got tested over the weekend, and ended up spending three hours in line. The hospital’s Tim Hortons was temporarily closed, and I couldn’t find a vending machine. I became extremely peckish, but stayed the course. Fighting this pandemic requires all of us to make sacrifices.
I’ve been writing about COVID-19 on and off since March, especially in regard to the propagation dynamics of large outbreaks. But till now, it’s all been theoretical for me on a personal level, because I’ve never been at risk. This changed when my family recently had brief contact with an asymptomatic friend who, days later, tested positive. Which is how all five of us ended up at the U Pavilion of Toronto’s Sunnybrook Health Sciences Centre, getting the upper reaches of our noses probed. The staff were great, and showed remarkable forbearance, even when it turned out that I’d wasted everyone’s time by bungling the admission protocols. (Since I’d come to this same facility in 2008 for an allergy test, I was told that I didn’t need to fill out Sunnybrook’s standard paperwork. I wrongly assumed this meant I could just skip the whole intake procedure, and so just plopped myself down on the examination table, somehow expecting that the nurse would be, like, “Oh look, it’s that guy from 12 years ago who’s allergic to peanuts.”) Plus, all of our tests came back negative.
For journalists who write about COVID-19, personal experiences like this can help provide perspective on big-picture policy questions. Most of our discussion about the pandemic is based on a macro-analysis of data trends. And this was the approach that informed my own journalism for months following the initial outbreak. I’d look at each day’s new numbers, plot graphs, extrapolate trajectories. This data-centric approach became a habit — and now informs comparisons between the first big wave of infections in March and April, and the current second wave that has accompanied colder fall weather and students’ return to schools. In Ontario, we’re now seeing about 400-700 new cases per day, up from an August low of about 100; the province expects to see as many as a thousand new cases per day later this month. When this information is presented graphically, it does indeed look like two waves separated by a trough.
But the focus on new cases obscures equally important trends, which you can see for yourself by scanning the publicly available data. The most important indicator is daily deaths — which remain in low single digits, just as they were over the summer. Intensive Care Units are operating at a tiny fraction of their spring peak.
Obviously, deaths and acute hospital interventions are a trailing indicator of infection. But it’s already been several weeks since schools opened, and several months since many (but not all) businesses returned to something approaching regular operations. Most of the new cases seem to be concentrated among younger people who are more likely to flout social-distancing obligations — in large part because the disease poses less risk to them than it does to, say, me. I see this in my neighbourhood: Parents still fastidiously making wide arcs around each other as they pass on sidewalks, while teenagers play driveway basketball and street hockey.
This is obviously not ideal. Teenagers can give the disease to parents, who in turn infect grandparents, who then get sick and die. (Indeed, one theory about why COVID-19 was so catastrophic in northern Italy is that multi-generational households tend to be more common in that part of the world.) But these transmission dynamics are now well-known, and one observes older relatives taking all sorts of common-sense precautions. As soon as my children went back to school, my in-laws made it clear that social visits would be confined to socially distanced outdoor chats and poolside barbecues. These ad hoc arrangements aren’t permanent solutions, obviously, but they provide one of the many informal behavioural checks that, collectively, have massively dampened society’s overall death risk.
Back in April, when I published my analysis of the available data on so-called “super-spreader events,” I reported that all of the numbers pointed to the main threat being ballistic large-droplet transmission through face-to-face contact, not fine aerosols or contaminated surfaces. The main risk was “parties, funerals, religious meet-ups and business networking sessions, all [of which] seem to have involved the same type of behaviour: extended, close-range, face-to-face conversation — typically in crowded, socially animated spaces.” I’m proud to say that this analysis has held up. And there remains very little evidence that normal forms of school attendance, shopping, appropriately regulated mass transit, or socially distanced forms of professional collaboration systematically spread this disease.
But there is abundant evidence that parties, bars, and musical events are extremely dangerous, since they all invite close forms of socially animated contact — often lubricated by liquor. (As I reported in April, singing is the probably the single most dangerous social activity you can do. Quebec recently banned Karaoke after a superspreader event at a Quebec City club infected more than 80 people. That place should never have been allowed to remain open in the first place.)
Back in the spring, I was primarily concerned with the physical means by which COVID-19 spread, including the complex mixed-phase fluid-flow mechanisms that governs the ballistic transmission of infected particles. But this engineering science is only half the story. The other half involves the many ways we have changed the human dynamics that govern our society — which, in their own way, comprise a giant engineering system. This is something I’ve been thinking about a lot since I got that test at Sunnybrook.
Specifically, I thought about what would have happened if my infected friend had gotten COVID-19 back in March instead of September. Without any kind of mass testing or proximity-based app technology in place, he would have gone around for days or weeks, infecting all sorts of friends, relatives and co-workers — including the elderly and those with medical comorbidities such as hypertension and diabetes, some of whom may have died. But none of that happened. As soon as he developed his first symptoms, he got tested, quarantined himself, and phoned everyone he’d been in contact with — a very short list, since even healthy people now tend to be limiting their exposure. Yes, he will show up as a new-case statistic, but the period of downstream exposure was sharply abbreviated, the damage was contained, and the age profile of his contacts skewed young and healthy. This is just one example, but it helps show why it can be misleading to analyze COVID-19 waves strictly according to 2-D line plots.
COVID-19 is a deadly disease, and the risk to public health will remain acute until an effective vaccine is created, tested, and administered on a national scale. We should all wear masks, listen to medical professionals (I’m not a doctor, by the way), and obey applicable rules. But absent some especially deadly viral mutation — or some massive U.S.-style political meltdown that destroys our collective trust in science — it’s unlikely that we’ll return to the time when hundreds of Canadians were dying from the disease every day. This is something to keep in mind amidst a journalistic environment in which pundits seem more vested in apocalyptic prophecies than applying common-sense cost-benefit analysis to save lives without shutting our schools or destroying our livelihoods.
Jonathan Kay is an editor at Quillette, and the former managing editor for opinion at the National Post.
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