Urgent Strict Measures to Counter Coronavirus Spread and Increase Public Education

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Dear Prime Minister Trudeau,

I am a Canadian Physician writing to you to express my concerns and urge your further action to aggressively halt the spread of coronavirus through this country.

First, I wish to extend my wishes to your wife and entire family during this difficult time.  I sincerely hope you all experience a full and uneventful recovery. 

Unfortunately, we know that many thousands of individuals in Canada are at significant risk of serious disease and death related to coronavirus and this risk increases further should these infections develop within a small time frame.  Physicians and allied healthcare workers across the country know that resources will simply not permit the ability to care for all affected individuals should this ‘spike’ in cases become a reality.

As we know, the incubation period can extend beyond 14 days (up to 29.9 days) before people start showing initial symptoms. Studies also shows that transmission of the virus does occur during the asymptomatic incubation period, where people can unknowingly pass the virus to their contacts as they go about their day to day life. If people wait until they become symptomatic before isolating themselves, they will have already exposed it to all their friends and families. By then the transmission would have already run its course.

We have seen multiple countries go before us in battling coronavirus.  We have seen their cases start slow, climb gradually and then explode. We have seen these countries enter unprecedented lockdowns following the spike in cases and we have seen all of this come too late for so many lives lost.  Overwhelmed by the disease, unable to treat so many, Italian physicians are forced to choose which patients will be offered life-sustaining therapy. In France, more than 50% of patients in ICU are younger than 60 years old. Italians, Spaniards and French have called out to us to cancel everything now, to learn from them, and honor the deaths they have experienced though implementing life saving measures now, to not repeat their same mistakes.

We have no proven therapies. We have limited capacity in hospital beds/ICU/ventilators and already short-staffed medical personnel.  We have limited protective equipment and sampling materials.  We are facing further depletion from colleagues who will be in quarantine due to exposure, infection or even worse complications. We have only proactive prevention in this golden window. We need to protect all health care professionals on the front line as there is already severe deficit in those as all suppliers of facemasks/N95 are in back order since end of February.

There are many reassuring steps that have been taken in Canada to date including school closures and immediate unemployment insurance in some provinces, travel advisories, restrictions on large gatherings and remarkable leadership from our public health colleagues all in efforts to flatten the curve of transmission.

However, while some bigger companies allow their employees to work from home, this is almost impossible to implement for a large proportion of the population, especially in fields of service, retail and manufacturing, to name a few. Employees, fearing loss of income and reprisals from employers or franchises, find it challenging to respect self-isolation after returning from travel. Employers, often themselves legally bonded by contracts, would not allow it without the situation becoming “more severe” or until obligated by the government.

Furthermore, confusion remains among the public; ‘Is it serious? Should I cancel my trip? Should I still attend this event?’. Mixed messages are rampant on social media - some reassuring the public that only the old with comorbidities die from it. This is not true. People take reassurance that our numbers of confirmed cases are “not that high”. What most don’t know is that by the time the official infection is confirmed, that patient could have unknowingly and silently already infected countless others during their incubation period. Thus, the confirmed cases numbers are always looking 1-2 weeks in the past. Furthermore, numerous patients might never get tested yet remain infectious if they only have mild cold-like symptoms, as there’s limited numbers of test kits. By the time it’s perceived as “more severe” in the eyes of the public, it will already be too late. The only way to limit this inevitable exponential spread of the virus at least 10 times more deadly than the flu is by immediately and aggressively limiting social contacts of all while most infected people are still asymptomatic.

The Health Ministry announced that 30-70% of Canadian population will get this virus. At least 10% of infected patients will require hospitalization for assistive breathing measure. At least 5% will require ICU for mechanical ventilation. Most critically ill patients have protracted disease and are at high risk of death. There are approximately 37 million people in Canada. Even if we assume only 30% are infected, it means 11 million Canadians will be infected and 550,000 will require ventilation. Our hospitals and ICUs are already running at 100% capacity. Mortality increases as health care systems gets overwhelmed, as seen in the 2-3% mortality in China compared to 6-7% in Italy as of today, further highlighting the importance of flattening the curve of transmission. Your actions today will prevent future premature deaths of countless Canadians in the 2-4 weeks to come.

I implore you to immediately enact aggressive measures that will both clarify the severity of this virus to our country and protect citizens from inevitable and catastrophic spread. I would suggest at least the following measures:

●      Close all non-essential businesses nation-wide immediately, including schools, malls, restaurants, leisure and non-essential community events, and keeping open only the absolute necessary services, including medical facilities, pharmacies, emergency/security services and groceries.

●      Government action for mandatory quarantine for the entire population, except those working in the essential services or sick patients requiring medical services and clear communication of the mandatory quarantine and what it entails

●      Close all borders for non-essential travel immediately and limit domestic travel to essential only.

●      All travelers need to be fully informed regarding self-isolation upon return from international travel, regardless of travel destination.  This is not currently happening with regularity, clarity or urgency at international airports nor border crossings

●      Continue to mandate that all returning travelers complete a minimum 14 days of obligatory self-isolation, regardless of their fields of employment. If they are only isolating themselves after showing symptoms, they would’ve already spread the virus to others

Due to the lack of understanding of the general population to the importance of self-isolation even when asymptomatic and the the business/legal consequences of self-isolation, effective proactive measures to flatten the curve of transmission and thus prevent the catastrophic spike of infection will not be feasible if not mandated by the government.

We already have documented community spread in Canada. By the time the situation appears dire enough for the general population to buy-in on drastic measures, it will be too late.  Proactive drastic action now, even if perceived as ‘overreacting’ and severely inconvenient to enact, is what is ESSENTIAL to save lives.  We have been gifted a remarkable opportunity to bear witness to China, Iran, Italy, South Korea and Europe’s tragic stories.  We have seen these unfold before us in the last 2 months and had opportunity to learn more about the virus along the way. We still have the gift of time to alter our course away from catastrophe, a golden window of time that is rapidly closing. We must be bold enough to alter our own ending to this story. 

Thank you for your immediate aggressive action to protect our citizens.

Regards,

Canadian Physicians