Canada's COVID-19 case numbers show early positive signs

Cases of COVID-19 are declining in many parts of Canada, but experts say those early positive signs are dependent on widespread restrictions.

Quebec, now under a province-wide curfew, has seen new cases decline.Ontariohas showed11consecutive declines in its seven-day average, a metric that helps to spotlong-term trends compared to daily numbers that can spike up and down.

Dr. Theresa Tam, Canada's chief public health officer, said Friday that national daily case trends are trending down.

"This gives us hope that community-based control measures are starting to take effect," Tam said. "But it is too soon to be sure that these measures are strong enough and broad enough to set us on a steady downward trend."

Caroline Colijn, an infectious disease modeller at Simon Fraser University, said most of the provinces seem to be declining.

"Ontario's kind of uncertain, Saskatchewan's growing still or again, but the rest are kind of flat or declining," said Colijn, who also holds a Canada Research Chair in mathematics for evolution, infection and public health.

"That's the first decline we've seen in Quebec and Ontario for quite a while," she said. "In our models, it looks like a genuine decline."

More tools needed

In B.C., for example, Colijn said the epidemic is stabilizing with strict measures such as telling people not to socialize outside their household.

But Colijn fears Ontario's stay-at-home order, Quebec's curfew and restrictions in other provinces aren't solutions that people can sustain for months.

If people don't limit their number of contacts with others then cases will start to climb again until vaccinations reach the general population.

"Unless we want to do this for six months, we do need to be thinking about throwing other tools that we have available at this problem."

Colijn said widespread restrictions, symptomatic testing and contact tracing remain cornerstone tools. But those tools should be supplemented with wider rapid testing technologies coming to the fore, which Colijn believes could support re-opening the economy.

Federal and provincial scientists are validating rapid tests, currently used at remote mines as well as thefilm and airline industries, for more widespread use.

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Sask. heading in the wrong direction

Nazeem Muhajarine, an epidemiologist at the University of Saskatchewan, divides the countryinto three main groups based on per-capita case counts:

• The top: Atlantic Canada, which has the fewest cases.
• The middle: Manitoba, Alberta and B.C., which have showed month-long improvements in COVID-19 activity following lockdowns. If trends in Ontario and Quebec continue, then they could be added to the middle group.
• The bottom: Saskatchewan, which Muhajarine said isn't even heading in the right direction, with anaverage of 300 new cases daily.

It is difficult to see stable epidemiologicalpatterns in the territories given the small population base, he said.

Muhajarine is concerned about the steep climb in COVID-19 deaths in the Prairie province.

"On Dec. 1, we had 51 deaths and by Jan. 1 it tripled to 155," he noted.

In the first 21days of the month, another 84people have died in Saskatchewan.

"We really need to reverse course," Muhajarine said. "To do that, we need very strict measures with a stay-at-home order and enforcement of orders. When we see the case numbers reverse course, we have to get our testing, tracing and isolation regime back up."

Restrictions on retail stores, restaurants and bars could help bring cases, hospitalizations and deaths down given how Saskatchewan is "stretched to the limit," he said.

Even places with early signs of decline, like Ontario, will see hospitalizations and deaths continue to climb for a periodbecause of the lag time from new infections in December, health experts say.

Essential workplaces key for Ontario

Dr. Sumon Chakrabarti, an infectious disease physician with Trillium Health Partners in Mississauga, Ont., said the province's seven-day averages are encouraging.

"We're now more than two weeks past what would be the New Year's surge," Chakrabarti said, referencing people socializing over the holidays despite advice from public health officials and politicians to stay at home.

Now that the holiday peak in new cases is over, regular winter transmissionof the virus is happening in the population, he said.

Chakrabarti recalls how during the province's first wave in the spring, cases came down and then were stuck at a plateau for months, which he said could happen again.

Driving casecounts down further would ease pressure on health-care systems and protect vulnerable residents of long-term care homes.

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The key, he says, is to tackle where transmission is still happening: essential workplaces.

"We were seeing people getting infected at work and then bringing it home to their family, where it was being amplified," he said of the first wave. "That's still happening and something a lockdown doesn't address."

It's why Chakrabarti and others advocate for:

• Improvements to paid sick leave benefits to allow workers to isolate without worrying about lost income.
• Targeted, rapid testing in more high-risk workplaces.
• More isolation centres to reduce household spread.

"Yes, there are some people who are breaking the rules," Chakrabarti said. "But we also need to look at the very different industrial setups because these factors are huge, right? This is one of the reasons why things haven't ever really turned quickly in Ontario."