COVID-19: lessons so far

While SARS-CoV-2 appears to be resurfacing in Europe and parts of Asia, we have entered a new phase of our lives with this virus, Dr.R Howard Nju, who played a leading role in the fight against the pandemic in the federal government, as the right hand of DD Teresa Tam, Chief Medical Officer of Canada.

Joining the federal government in 1996, the German-born Indonesian doctor and married to a Lac Saint-Jean native has a long career in epidemiology and public health, which he studied at the University of Toronto. DR Nzhu was active in managing the SARS crisis in 2003 and was also sent to Haiti after the 2010 earthquake and to Guinea during the Ebola epidemic. “We are emerging from the crisis phase of COVID-19, but the work is not over yet, because now we must determine a new way to deal with the virus in order to minimize its consequences,” explains the doctor, whose team will publish in a few weeks a guidance document on this issue, intended for provincial governments.

What important lessons has the pandemic taught you?

There are so many things! Now is a good time to take stock. If we want to focus on the most important points, I would say that she identified three main advantages and three disadvantages. As far as strength is concerned, we must start with science: it’s incredible, everything that research has discovered in two years, even if it continues to develop. Just think about the way the virus was transmitted: at first, everyone, myself included, thought it would behave like other respiratory viruses. [NDLR : diffusés par des gouttelettes], whereas we now know that it spreads like cigarette smoke. This made us realize that ventilation and close contact management in closed and crowded areas is critical.

The second strength is obviously the vaccines, which were developed very quickly and then distributed in Canada to the vast majority of the population. There is work to be done there too to build confidence and accelerate the spread to other parts of the world, but it is hard to imagine the scale of the drama we would experience without vaccines!

And the third force is the mutual assistance of Canadians in the face of this enemy. We have seen many people willing to help, buying products for others and agreeing to follow instructions to protect themselves as well as protect others.

And from the side of weaknesses, what needs to be addressed?

First, to the inequality in our society, which means that many people have been affected much more by COVID-19 than others: marginalized, racialized populations, people who cannot work remotely, essential workers, those who do not have vacation due to sickness… We must do better to protect everyone and also think about the value we place on older people in our society.

Second, COVID-19 has shown the fragility of our healthcare and public health systems. We must prepare better, use technology better, but above all, do our best not to burn our personnel.

Finally, disinformation is a huge issue that continues to be a big concern.

The way we deal with COVID-19 has begun to change under the general influence of pandemic fatigue, availability of express tests as well as lower virus virulence for people protected by vaccines or past infections. How does all this redefine the role of public health?

We are moving from a strategy of identifying all cases and their contacts to a surveillance strategy to more generally monitor the circulation of the virus and the variants that may emerge by combining several tools. PCR tests will remain necessary, but not for everyone. They should be reserved for the most vulnerable people, such as older people in residential buildings and immunocompromised people, as well as healthcare workers. They can also be deployed locally, in certain communities to serve as sentinels for surveillance, and at borders to sample viruses that travelers might bring. Wastewater analysis is relevant for detecting a surge in the circulation of the virus, as is monitoring school absences. Finally, the number of hospitalizations should remain a key indicator, because even if they increase only two to three weeks after the start of the wave, they are the ones that allow us to assess the virulence of the virus. Rapid tests will remain a very important tool in case of symptoms and for notifying contacts. But we must continue to explain when and how to use them, especially since this can change depending on the circulation of the virus.

Can vaccination rates be further increased?

We will never reach 100%, but we must continue our efforts. However, the means must change. Now there is not much time for big commercials on TV. We need to focus our efforts on population subgroups with lower vaccination coverage. Work more with leaders in racial or even religious communities and develop new tools aimed at young people, especially on TikTok. In addition, the government wants to support innovation, for example by healthcare professionals, to improve vaccine awareness. It will be a big challenge to convince the population to stay up to date with their vaccines, we can already see this with the third dose, which too many people have avoided.

And as for health measures, what awaits us?

Several authorities have lifted the obligation to wear a mask indoors or are preparing to do so. But it’s important to reinforce the message that masks will still be useful, for example, if you’ve been in contact with an infected person, if you need extra protection because you’re immune-suppressed, or you’re in a crowded closed place, or even in hospitals. You should keep the habit of wearing a mask to go grocery shopping, for example, when you are a little sick, even if you do not have COVID. We need to leave people who feel more comfortable wearing a mask the option to keep it on, and reinforce the idea that masks allow you to protect yourself and others. As a public health authority, we must also learn to better understand and manage population expectations in order to anticipate the problems that could arise if we restore health measures when the next wave arrives.

For the last two years, we have relied heavily on public health to tell us what to do. What do you expect from the population now?

To ensure that the virus no longer has serious consequences for society, everyone must do their part and learn how to manage the risk to themselves and others. We still have much to learn in this area. What is needed is for everyone to develop the reflex of looking at some sort of COVID “checklist” before considering a trip or any activity to assess this risk. It goes through five questions:

1) Am I getting my vaccinations as recommended?

2) What is my personal risk of contracting COVID, based on my age and health status, and the risk to the people I meet?

3) What is the current epidemiological situation, are we in a period of many cases and a new variant, for example, or rather in a calm phase?

4) What is the risk associated with the activity I want to undertake – for example, if I want to travel, will I be in nature or rather enjoy the nightlife in the city?

5) What are the public health rules or customs at the place I want to go – will I run into problems if I wear a mask, can I distance myself as much as I want?

Will decision makers and the public listen to you?

I believe this, even if it remains difficult to demonstrate the success of a preventive public health approach. Modeling, in particular, has helped us understand the benefits of measures that can be taken to prevent cases. I also have a feeling that decision makers and the public have a better understanding of what public health is. I’m optimistic because we’ve all learned a lot and we’ve managed to adapt. But we must not forget our serious problems, especially vulnerable populations, which we all have a duty to protect.

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