Aggressively find, test, trace and isolate to beat COVID-19

While we were caught off guard in March when COVID cases spiked in Canada, there is no excuse this time around. We are far from COVID herd immunity, antibody tests are not reliable indicators of protection, approval of a vaccine is months away, so we are left with the same arsenal of public health measures to prevent and protect us from the second wave, which may be even bigger and longer as our Canadian winter approaches.

To prevent outbreaks that can lead to the second wave, each new diagnosis of COVID (i.e. index case) requires rapid intervention and containment at the source since up to 1 in 5 secondary cases may have no symptoms leading to undetected ongoing spread. All close contacts of the index case must therefore isolate for 14 days and ideally should be tested for COVID (i.e. “Ring Testing”). In school settings, for instance, isolating for 14 days and immediately testing all household members of the index case is important to identify secondary cases among siblings or parents to identify other classrooms and/or workplaces at risk. For each classroom exposed, isolating for 14 days and testing all teachers and students on day 5-7 post-exposure (i.e. the peak incubation period) will further identify secondary cases but even those with a negative test still need to complete the 14-days and be retested if symptoms develop. Due to ongoing exposure to the index case, at the end of the 10-14 days isolation period (or longer if the case remains symptomatic), the entire household should be retested (i.e. “Serial Testing”) before the index case returns to school.

Rapid identification of index cases, 14-day isolation of contacts with ring testing and serial testing are proven approaches to prevent COVID outbreaks. Preventing disease spread and further lockdowns requires close attention to local epidemiology. Areas with no new cases, no ongoing hospitalizations, and ideally no active cases for several weeks, should cautiously resume school and work activities while maintaining high rates of testing.

These are stressful times and in the context of a pandemic, trauma-informed public health is needed. Different people have different life circumstances, different health concerns, different family structures, different risk tolerance thresholds. A nuanced and flexible approach offering in-person and remote learning and working options creates an atmosphere of trust, safety, choice and control, which are key elements of a trauma-informed approach. The Canadian economy will recover more quickly by containing COVID, being patient and waiting until few to no active cases in a given region, reducing travel that could import cases, and enabling people in COVID-free zones to safely get back to business.