A peak at the World’s response

South Korea has been recognized as one of the best organized epidemic control programs in the world, this country showcases as a model and proof of the capacity of a well-organized democracy to respond to a pandemic. Solutions go from transparent communication through technology and massive screening throughput of 20000 tests per day, to tracking of the journey of every positive case and empowering the population with a common cause. Along with Singapore and Hong Kong, these countries were able to keep most factories, shopping malls and restaurants open.

Adding to the list Taiwan, which reported it’s 100th case in mid-march and today, has almost fully eradicated the virus despite its proximity to China. With its 24 million people, and now less than 10 new cases per day, Taiwan has recorded the lowest case rate per capita, around 1 for each 500 000. In contrast with the Western world, Asian countries have qualities that explain their success in controlling the virus such as a more central approach of authority and a deep sense of community solidarity. Due lessons learnt from the SARS epidemic in 2003, their population is very aware and conscientious of public health, thus mobilizing to national threats, which aid the government’s measures to become much more effective.

Employees sit behind protective screens as part of preventative measures against the novel coronavirus as they eat in a cafeteria at the offices of Hyundai Card credit card company in Seoul on Thursday. Hyundai Card has implemented reduced working hours and staggered lunch breaks. (Ed Jones/AFP/Getty Images)

Many Western countries also did effectively contained the spread so far, countries such as Germany, Denmark, Australia and Austria. In fact, Austria announced this weekend lifts of measures and an exit plan starting today, April 14th, becoming the first Western country to reopen its economy. They will start by opening small stores and parks. Every two weeks there will be a re-assessment and to lift new measures if everything is under control. From May 1st all shops, centers and hairdressers will be allowed to open. Schools are also expected to open during May.

The 9 months strategy

There are many tactics involved in deconfining a population where a virus is active and propagating itself. Since there isn’t a vaccine widely distributed, the main strategy consists of building “herd immunity” to counter the spread. The way to do this is to progressively lift confinement measures, a process that can only start if these preconditions are met: public health capacity, community mobilization and education, massive testing, case investigations and limitation of the reproduction rate. During this process, more and more businesses would re-open, industry per industry, region per region following strict regulatory measures always in a balance with hospital capacity.

The rationale behind group immunity is to gradually deconfine subsets of the population to slowly create shield against the virus which will eventually block the circulation of virus. The required percentage of group immunity required to stop the spread hovers around 55% according to a CDC study. That percentage is determined based on the nature of the virus, more specifically from its rate of reproduction, which is between 2 and 3. In comparison, measles had an R0 of 15–17, which means that for every infected person 15–17 other people would contract it, the group immunity would have to be 90% for the virus to stop to spread.

The target population and regions chosen are defined by the WHO seroprevalence protocol. This process is done by sampling random regions and groups of individuals to identify positive cases by looking for SARS-CoV-2 antibodies through blood tests. A 1% group immunity for a particular region will have a very different course of action than a region having more than 50% of the population that had contracted the virus. The less the virus spreads, the higher the risk of fast peaks and overcharged health care system, resulting in more deaths.

The other parameters for a progressive deconfinement are age and health conditions of groups of individuals. In fact, we know now that children and young people are less at risk of developing complications of the virus. Hence, one could allow a portion of kids having healthy parents with no chronic diseases (cardiac, diabetes, respiratory chronic, etc) to start going out. Some may suggest that contagion rate is reduced for children, but this hasn’t been proven yet. What has been proven, as Professor Dale Fisher says, chair of the World Health Organisation’s Global Outbreak Alert and Response Network, is that children are less at risk of developing a severe form of the disease. And since testing children are not prioritized, less positive cases are reported. Children may remain a transmission vector, but since hospital load won’t be affected by it, they suddenly become a logical first step towards herd immunity.

And as it builds up, teenagers and adults would stop quarantine as well as re-opening up specific industries, while keeping the elderlies completely isolated from the rest of the population until a vaccine is out or an immunity passport is widely implemented.

A potential scenario for Quebec

The following section, the numbers, dates and measures are purely subjective. I made my own conclusions and predictions based on my own intuition and none of it should be treated as a reliable source of information.

A Lazy Model for my COVID-19 Predictions (QC) https://docs.google.com/spreadsheets/d/1JJR8pE4aYgNKUJbBsh7OazSmEdcDXfueZKwdnZK6l8w/edit#gid=293475353

In Quebec, we are entering the second phase of the epidemic as the hospitalizations decrease and the number of new cases stabilizes, which means not crossing the 800 new cases/day threshold. The peak of the first wave should arrive by the end April hovering around 15000 total cases. Until now, we’ve only faced operational issues such as medical equipment supply (which have been mitigated) or drugs shortage, such as propofol. Therefore, we can say that we were successful in mitigating the overcapacity risk of the healthcare system. With that in mind, we can assume that soon enough the progressive deconfinement will happen, following the strategic plan based on public health. For the next several months, we can expect that public gatherings of more than 10 people will remain forbidden, that maintaining 2 meters between individuals will persist and that travel and borders will remain closed.

More concretely, it is expected that by May 18, construction workers and a portion of small commerce will likely reopen, alongside some daycare and “street” hairdressers. These industries are seen as the most pressing to re-open in order to jump-start the economy and relieve stress on targeted households.

By June, small gatherings will be allowed and city parks will reopen. Along with strict distancing and sanity measures, malls and restaurants will begin to re-open with limited capacity 50% capacity to serve too-long-craving consumers. Downtown Montreal will slowly start to see its activity rising back again, while shopping and transportation activities will require face masks or homemade covers.

In fall, colleges and universities will partially reopen, with limited attendance, forced remote classes for many. Entertainment and culture events such as sport, gyms, bars, clubs, festivals won’t see their doors reopening during summer. Elderly people living in CHSLD or in residencies will be constrained to isolation until a technology such as immunity passports gets massively adopted. Tourism and travelling won’t be possible at least until 2021.

A second wave can be expected to happen: as we reopen the market the virus will start spreading aggressively. For that reason, we will need to reopen slowly, as well as leverage massive case investigations and testings. This will aid to quickly identify local outbreaks and isolate them, to prevent from the chain of contagion. This way we will ensure that we have a proper balance of the variability of the hospital capacity and group immunity growth.