The Puzzle of a Riddle in a Conundrum

"Unfortunately, the hard reality is that we don't know that much [about transmission sources of COVID-19]."

"Without being able to do extensive contact tracing, it's hard to know what's exactly happening, and without knowing exactly what's happening, it becomes virtually impossible to have any success stopping this disease by imposing very minimal, targeted restrictions."

Dionne Aleman, engineering professor studying health-related systems, University of Toronto

 

"If we don't understand how and where people are getting infected, it's very hard to control this disease." "It suggests that our contact tracing is not up to the level that we wanted it to be." 

"[Measures to reduce the spread of COVID-19 need to be based on good data about the types of locations and activities that are driving the increase in infections]. If we have a large number of cases who are getting infected and we can't trace where they're getting their infection, it's really hard to respond to that."

Ashleigh Tuite, epidemiologist, University of Toronto's Dalla Lana School of Public Health 

A high proportion of the new cases don't have any epidemiological link, meaning the coronavirus is spreading in the community. And, more than half of Ontario's active confirmed cases of COVID-19 are in just two public health units, Toronto and Peel Region. (Evan Mitsui/CBC)

There it is: where do these increasingly rampant infection outbreaks seed from? Inadvertent contact in bars, restaurants, shopping malls, hospitals, factories, schools? Private homes hosting discreet parties? Backyard, indiscreet barbecues? Weddings? Funerals? All possible vector-venues, including protests against lockdowns where certain demographics spurn mask-wearing and social distancing. And let's not forget houses of worship where some clergy boast that faith will keep their congregants safe from infection.

 

What is certain, is that without knowing how and where and when transmission takes place, how are medical authorities and governments supposed to make knowledgeable decisions about measures to take to slow down the infection rate with a view to countering it entirely? Restrictions imposed as case numbers continue to rise, on bars and restaurants may make the governors of society feel that they're doing something usefully important, while cringing at the reality that those imposed regulations are doing grave harm to the economy, but business owners are livid.

 

The fact is, there's a shortage of reliable statistics, no publicly available data to hang decisions on. And tens of thousands of businesses have closed for good, taking with them hundreds of thousands of jobs. In East Asian countries contact tracing swiftly became a key portion of their successful strategy to contain COVID-19. Their Western counterparts took note, and did their best to emulate that strategy. Sometimes, somewhere with a good degree of success. But not in Canada.

 

In Ontario, Canada's most populous province, an estimated 60 percent of infections have no identifiable source of the viral invasion. In Canada's largest city, Toronto Public Health pretty well put an end to its work in contract tracing, swamped by the surge in the infection rate. British Columbia, now seeing its infection rate surging, is in a similar position. Leaving Professor Aleman to question why more was not done to support resources at chronically understaffed public health agencies to enable contact tracing as the disease has spread.

 

Ontario's COVID-19 Science Advisory Table estimated the percentage of virus outbreaks defined occasionally as  two or more people infected from one source in different venues and the largest portion, 27 percent were in long-term care and retirement homes, then schools and day cares, at 22 percent. Restaurants, clubs and bars came in at 6.5 percent, stores at 5.6 percent and gyms at 3.3 percent. And yet the restrictions targeted restaurants, clubs, bars and gyms.

 

Montreal's health department tracking COVID-19 outbreaks found shops of various types representing the largest source of infection; 50 of a total of 151, followed by the service industry that includes bars, gyms and hotels, for 26 outbreaks. Before putting an end to contact tracing Toronto Public Health pinpointed 18 of 45 outbreaks in a September week to be in restaurants and bars.

 

In Alberta, its premier announced a mere three percent of cases stemmed from restaurants and he "did not see any data" suggesting they should be required to close. British Columbia's chief medical officer of health noted early in the week that people could continue eating out, but in the company of their core household bubble, that the province hasn't seen much transmission in restaurants taking adequate anti-COVID precautions; restaurants safer than people loosening their safeguards getting together at home.

 

Head of the infectious disease division at Queen's University, Dr.Gerald Evans who acts on Ontario's COVID scientific advisory table, states the limited data so far released views outbreaks accounting for less than ten percent of transmission in the province, and that 60 percent of cases fall into a blind category, the setting where people contacted the virus unknown. Dr.Evans states that evidence points to where people congregate for socialization.

 

A Massachusetts Institute of Technology paper indicates data that prior to the pandemic, indoor dining was responsible for the largest proportion of socialization encounters, some 13 percent, followed by fast-food outlets, stores, gyms and other venues, research that failed to ascertain how much socializing occurred in private gatherings. 

 

"We know that when we don't mandate or restrict things, people will naturally go back to those specific circumstances where they tend to socialize. If  you look at the States now, that likely accounts for why they are just out of control down there", pointed out Dr.Evans. "There's very little data to support that statement", that most of the transmission is occurring in private homes.

 

An estimated ten thousand restaurants have closed permanently in Canada Todd Barclay of Restaurants Canada points out, even while operators spent about $750 million on protective measures. His own members' experiences are that eateries are less responsible for the spread of COVID than are drinking establishments, and he wants governments to release data separating restaurants from bars.

"The problem for us is we aren't getting the information to suggest where it's happening."

"They're trying to get out of it and they're guessing at where they should focus versus using data to allow them to focus on the areas creating the biggest issues."

Todd Barclay, Restaurants Canada

Only one out of every five cases of COVID-19 has been a result of community spread, according to data from the Toronto and York Region public health units. The bulk of confirmed cases have been spread in institutional settings such as long-term care and through other close contact, such as in a household. (Evan Mitsui/CBC)