Canada prepares to tackle COVID-19 on a city-by-city basis as outbreak diverges

Canada prepares to tackle COVID-19 on a city-by-city basis as outbreak diverges
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The fight against the COVID-19 pandemic was originally framed in wartime terms, as a national struggle. Then we divided along provincial lines as the virus took hold in Quebec and Ontario, leaving places like Manitoba and New Brunswick virtually untouched.

Now, cities are preparing to tackle their own unique outbreaks as the initial wave of infections turns into a series of localized eruptions.

Consider the situation in Kingston, Ont., where the city of about 137,000 people has seen 63 confirmed cases of COVID-19.

By Tuesday, 62 of those cases had resolved, leaving a single confirmed case in the community. There have been no deaths and no outbreaks in long-term care homes, yet people in Kingston are still living under restrictive stay-at-home orders issued across the province.

“A one-size-fits-all approach is becoming increasingly difficult,” said Kingston Mayor Bryan Paterson in an interview with the National Post.

To put the numbers in context, Ontario announced 446 new cases on Tuesday, seven times more than Kingston has experienced in total since the first COVID-19 case arrived in Canada.

“I’m speaking with mayors in the Toronto-area saying things are moving too fast for them. And then you have situations in Eastern Ontario like ourselves where we’re hearing from our own public health officials that we’re ready to move to the next stage. That’s showing there’s a real case for a regional approach,” said Paterson.

It’s a similar situation in Ottawa, where the city has reported new cases in the single digits for the last week and, although there are 18 institutional outbreaks in the city, only 187 confirmed cases out of 1,969 were acquired in the community. People in Ottawa have endured the provincial mandates and city rules against lingering in parks, along with some of the most overzealous bylaw enforcement in the country.

After resisting a local approach to the crisis, the Ontario government seems to have had a change of heart.

“We need a plan that recognizes the differences on the ground in different parts of our province,” said Premier Doug Ford on Tuesday afternoon. On Friday, Ford announced that the plan to open up will go forward on a regional basis, but few details about how that will look have been revealed. It could go city-by-city or allow the regional health authorities to set guidelines. In Quebec, for example, the province is split between Montreal and everywhere else.

Some kind of regional approach is already underway in much of Canada and the United States. The rules in New York City are different than the rest of the state and Montreal is opening on a slower timeline than the rest of Quebec. An outbreak in a meatpacking plant in Calgary forced it to labour under stay-at-home orders longer than the rest of Alberta.

We need a plan that recognizes the differences on the ground in different parts of our province

Paterson said he’s not sure why Ontario resisted the regional approach until Friday, when most of North America was moving that way, but said he’s pleased to see the change in direction. With that new approach comes new challenges, though.

For one, how do you keep people bringing the virus into the newly reopened cities?

“We can do things different regionally if we have a way of monitoring travel. At the borders between provinces, at least we can talk to people as they’re moving across that border. We can give information, we can require people to self-isolate for two weeks when they arrive,” said Colleen Davison, social epidemiologist and global health researcher at Queen’s University. “We can also take the cell phone number or contact information for those people, and that makes it okay to have different rules or different approaches in different places.”

Aside from stern warnings from public health officials and politicians, there’s not much to stop people in hotspot cities from driving down the highway to get a haircut or to visit family members. There are no borders and setting up checkpoints would be difficult in cities with so many entry points.

But Davison said people in cities with barely any trace of the virus won’t stand for restrictive measures much longer.

“It’s a tough balance to strike. The fatigue is real. In this case, it’s starting to become more of a burden. And it’s a burden for a lot of people,” she said. “In areas where there’s very few cases now, and they’re able to kind of keep track of who’s traveling in and out, it might make sense to soften up some of the physical distancing measures.”

Public health officials see the resurgence of the virus less as a wave across the whole country but a series of local hotspots and some experts are recommending that countries prepare to fight a potential second wave of COVID-19 infections at the local level .

“The case for the regional approach is being more driven by what’s ahead of us over the next year than what’s behind us in the last couple of months,” said Paterson.

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