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November 25, 2020

The sharp escalation of COVID-19 cases this fall has highlighted the problem of governments’ extensive reliance on emergency powers and far-reaching orders that limit activities. Their “acute crisis” approach reflects an undue focus on vaccines as the dominant near-term solution to the pandemic. It neither recognizes nor addresses the uncertain timeline and other major challenges until safe and effective vaccines are available, well distributed, and sufficiently taken up.

Despite the very encouraging recent progress on vaccine development, vaccine-centric policies have led to serious weaknesses in government communications and inadequate resources to deal with the current resurgence. It has made the re-imposition of tough restrictions this fall, including partial-to-full lockdowns, the default policy response. In contrast, an approach based on COVID as a “chronic condition” — focusing on effective communications and the “three Ts” of much better testing, tracing and treatments — is crucial to managing COVID’s impacts and transitioning effectively to a vaccine solution.

Better communications

Most people are poor at assessing risks, often fail at reflecting risks in their actions, and frequently minimize risk when it’s convenient. This is especially problematic with the pandemic. While fear may work to motivate behavioural change in the short term or in an emergency, fear loses its effectiveness beyond the near term. Decision fatigue, information overload, and other major behavioural challenges overwhelm people in ongoing stressful environments.

Enhancing government communications starts with clearer, simpler, and more consistent messages, beginning with the need to avoid the “three Cs”: closed spaces, crowded places, and close-contact settings. Using credible and trustworthy spokespeople and influencers is vital, especially online.

Communication must convey the importance of individual agency as the core part of improved messaging. People’s efforts in wearing masks, keeping socially distant, and not gathering in indoor spaces with poor ventilation or in large numbers when this can be prevented need to be better explained as an ongoing essential requirement. Mixed messages about the pandemic potentially (and unrealistically) subsiding by near-term dates (e.g., Thanksgiving, Christmas), and errors in not requiring more than short-term behavioural efforts have been highly problematic.

Testing

Thoughtful compromises need to be made to allow for far more testing and faster processing of results. The current gold standard for detecting COVID in Canada and globally is called polymerase chain reaction (PCR). However, PCR testing is resource-intensive and has proven to be very challenging to scale up when infection rates have surged. As a result, Canada’s overall testing remains far below desired and necessary levels.

Adding large-scale rapid antigen testing is a much less resource-intensive option to reach the total testing needs. Germany’s, Slovakia’s and the U.K.’s massive antigen initiatives, as well as empirical studies, suggest a much-increased use of rapid antigen tests could be very beneficial in offsetting Canada’s lack of PCR testing capacity. In parallel, critical PCR testing deficiencies, such as insufficient and slow investments in equipment and facilities, poor logistics management, and shortages of skilled personnel, need to be urgently addressed.

Tracing

All three levels of government should focus on the problems of funding, training, and logistics that are plaguing local contact-tracing efforts. They may include using regulatory and legislative means to improve tracing capabilities in order to ensure the adoption of nationwide tracing technology. While Canada’s COVID Alert mobile app is an easily accessible tool to track transmission, its effective mobilization to date has been limited. Tying increases in health-care transfers to the adoption of a common technology for tracing needs to be considered.

Treatment

Medical treatment and understanding of COVID have improved rapidly and significantly in 2020. These advances have been vital in keeping mortality at much lower levels this fall compared to earlier in the pandemic, despite COVID’s resurgence. Notably, certain drugs and other treatments have shown promising results, but concerns include the availability and distribution of these therapies, such as Eli Lilly’s new antibody drug, and insufficient investment in and use of other treatments, e.g., corticosteroids and proning.

In sum, as the scientific understanding of COVID-19 continues to evolve rapidly, treatments and vaccine solutions should occur that materially improve the path to containing the virus, its health risks, and its economic costs. However, massive production of vaccines, along with their widespread distribution and take-up, won’t occur until well into 2021, at the earliest.

There is a clear need for a new communications and public-policy approach — one based on the principles of managing COVID as a chronic condition to bridge to this eventual solution. Better messaging on the three Cs and investing in the three Ts will help improve control, slow down community spread, and support COVID’s elimination.

Published in iPolitics

Hugh O’Reilly is executive director of Innovate Cities and a senior fellow at the C.D. Howe Institute. Matthew Bourkas is completing his PhD in life sciences with a focus on infectious diseases at the University of Toronto. James K. Stewart is an economist and is president of Pol-Econ Canada Research Inc.

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