1/

So #COVIDzero is trending.

What's not to like about zero cases of #COVID19?

1. How can we get there?
2. Is this feasible in Canada?

Some unpopular opinions & perhaps a few hard truths below...

2/ With a #COVIDzero strategy or not, it is clear that we should improve/continue to:

1. Evaluate & address drivers of #COVID19 in the community

2. Bolster a Test-Trace-Isolate-Support system

3. Support communities & businesses disproportionately impacted by the virus

BUT...

3/ What would it actually take to *operationalize* #COVIDzero in Canada? How do we get to (or near) zero cases & maintain it?

***It would take prolonged & full lockdown (3-5 months based on current burden?) where #COVID19 is crushed, then ongoing supports to suppress this***

4/

Some notable successes include Taiwan, New Zealand, Australia, Atlantic Canada, and a few others...

And they are reaping the rewards.

5/ But several of aspects to achieve #COVIDzero must ALIGN to be successful (e.g. like that Swiss cheese model), including:

1. Federal government support
2. Federal public health support
3. Provincial government support (all)
4. Provincial public health support (all)...

6/
5. Municipal government support (all)
6. Regional public health support (all)
7. Community buy-in for prolonged pan-Canadian lockdown
8. Enforcement of lockdown measures
9. Massive support for communities impacted by lockdown
10. Support+++ for businesses impacted by lockdown

7/

11. Halting interprovincial travel

12. Halting regional travel (eg 5 km radius from home in Victoria, Australia)

13. Bolster diagnostic testing capacity country wide

14. Bolster contact tracing capacity country wide

15. Stay at home orders (no private social gatherings)

8/

16. Ensuring everyone who cannot isolate has a safe place to do so, even if they don't want to isolate...

17. Creating a reliable pan-Canadian surveillance program (e.g. waste water, syndromic surveillance, etc)

18. Ensuring supply chain intact for medical & essential goods

9/

19. Strict border control/screening for incoming people & goods (see link below & the tremendous volume of travel over Canada/US border for *essential* goods)

20. Ensuring safe workplaces (e.g. factories, etc), systems in place for paid sick leave.

https://ontruck.org/freight-economy/

10/

I am sure that I am missing some major ones above - please add/correct any. This is just a first pass.

11/
Think of what it takes to achieve #ZEROcovid. Realistically, how successful have we been with many of these like testing, contact tracing, surveillance, supporting marginalized, esp. in hot spots?
...
Now ask yourself is #COVIDzero probable, aspirational, feasible?

12/

I think we have to be honest with ourselves & the public about what it would take to get there, what our capacity/appetite is, & the likelihood of this being successful.

And of course, it would be great to have zero (or near 0) #COVID19, but will we?

13/

Also consider timing - getting to or near zero covid will take ~4+ months, around the time vaccine roll-out is likely to start (which will take time to do country-wide) & will prioritize the most vulnerable populations first e.g. those in LTC, who account for >80% of deaths.

14/

Soooo....

1. CAN #COVIDzero work? Theoretically possible.

2. WILL this work? Canadians will have to decide, not just those on Med/Epi/COVID twitter.

3. Regardless of #1 & #2, SHOULD we drive cases lower, boost Test-Trace-Isolate capacity, support vulnerable? Of course.

ADDENDUM:

Let's talk #COVIDzero when a vaccine rolls out.

Or aim for something realistic, like zero #COVID19 deaths.... https://nationalpost.com/opinion/opinion-were-infectious-disease-experts-and-eliminating-covid-wont-happen-any-time-soon