2020-11-22 - COVID strategy

COVID-19 cases are rapidly growing in Alberta. If we don't act quickly, we'll soon have case loads comparable with our US neighbours. That's crazy! We're better than that.

What's driving the growth? Nobody knows for sure, but my guess is a few things:

• It's cold outside. Everybody has moved indoors. Transmission is much worse indoors.
• COVID fatigue. We're all tired of restrictions and there are all sorts of people who are just ignoring the rules. Large house parties, weddings, late nights at the bar, etc.
• Thanksgiving. Canadian Thanksgiving was a little over a month ago and lots of people probably had large family gatherings. This created a big bump in transmission.

Interestingly, some things don't seem to be big drivers of transmission:

• Schools. Given the huge number of kids in schools and the high population density, the case loads in schools are tiny. This is likely due to the fact that COVID-19 is not particularly hard on kids (low infection rates, low viral loads from infected kids, limited symptoms) and robust procedures to contain disease in schools.
• Stores and restaurants. Stores are limiting the number of concurrent customers and requiring masks. Restaurants have reduced capacity and staff wear masks.
• Outdoor activities -- hiking, running, biking, skiing, snow shoeing, etc. This bug is just not that good at infecting people outdoors, thankfully.

Some things are a "maybe" - they look like they should probably cause accelerated spread, but I haven't seen evidence to back that up. This includes spin studios, gyms and religious gatherings.

Make no mistake, the infection numbers are large. While we can't directly compare positive tests against those early in the pandemic due to increased test capacity, we can compare daily hospitalizations and deaths -- those don't depend on how many tests are available. The growth is alarming and shows that the disease is much more prevalent now than it was in May:

COVID metrics in Alberta

Since spread is exponential, we have to respond quickly or else things will get out of control. It's hard for humans to think about exponential growth processes, but we must, because nature doesn't care. Unchecked, the first impact will be that the health system will stop being able to support non-COVID patients, as COVID patients overwhelm both regular and ICU hospital beds. After a while, again if we don't manage transmission, it won't be possible to treat even all COVID patients. AHS is already losing the capacity to support non-COVID patients.

So what should we do?

• Manual contact tracing is no longer useful. It can't possibly keep up. Consequently, we have to switch to patients doing their own contact tracing. The best way to do that is with a tracing app:
  • ABTraceTogether was an early success, but apparently still doesn't work well on iOS.
  • ABTraceTogether is designed to notify human contact tracers of positive cases and their contacts. This model does not scale.
  • It's time to adopt the national contact tracing app!
    COVID Alert. The federal app was late to the party but seems to have better technology and is designed for self-service tracing - a more scalable model.
  • There is no need to migrate legacy users to the new app. People who were "with it" enough to deploy one app will deploy the new one. There is not much legacy data to migrate over, so it's better to just cut over now!
• Contact tracing apps are only useful if widely adopted:
  • Neither ABTraceTogether (in Alberta) nor COVID Alert (elsewhere in Canada) is widely adopted.
  • We have to drive higher adoption now!
  • Part of that is a renewed public awareness campaign.
  • Another, more useful strategy would be for businesses to require that employees and visiting customers prove that they have a phone with an active contract tracing app.
  • We really need another app, or another mode in COVID Alert, which just displays the signal strength from nearby phones with the same app.
  • Businesses would use this to control entry to indoor spaces -- blocking entry by adults who don't have a phone with the app on their person.
• It's time to lock down some businesses again.
  • Salons and spas.
  • Bars.
  • Gyms and spin studios.
  • Churches and other religious gatherings.
  None of these are essential. Businesses should be compensated for their losses, to help them survive this.
• We have to get a handle on personal gatherings. Most of the transmission is likely happening in homes.
  • Citizens should call the police when their neighbours have large gatherings.
  • Yes, I know this is a terrible thing! But death by COVID is worse.
  • Police should try to educate, not ticket and certainly not arrest anyone.
  • Repeat offenders should be ticketed. Large fines -- thousands of dollars.
• The media needs to focus on the human cost of COVID-19.
  • A daily story, picture or interview with tired healthcare workers.
  • A daily story, picture or interview with families who have lost loved ones.
  • A daily story, picture or interview with patients who have had COVID-19 and now suffer from long-term side effects.
  Lots of people don't seem to "get it" and hopefully putting a human face on it will help.

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