A “No More Waves” strategy for COVID-19 in Canada

Doctors Morris and Mintz propose using public health measure to bring case rates of COVID-19 to 3/100 000 population using a matrix of actions. However appealing it would be to think that we could rid ourselves of COVID-19, this approach is unrealistic and potentially harmful.

Despite the published matrix, the relative efficacy of restrictions remains unquantified. For example, masks are identified as highly effective, yet the data are weak at best. Other measures have also been evaluated in aggregate and none seem to correlate with better outcomes. To date, no intervention has been shown unambiguously effective in controlling COVID-19, and some proposed interventions are untenable (e.g., closing essential retail) or incredibly damaging (e.g., closing schools).
It is impossible to accurately describe the social and economic impact for all people. As proposed, the matrix downplays impacts on single parents, youth, and workers whose physical presence at work is necessary (e.g., Manufacturing, personal care, service industries). The proposed approach will actively exacerbate existing inequalities, as the people most impacted by restrictions are those least likely to benefit. Furthermore, the proposal ignores unintended health consequences of all measures which are significant, and may exceed the benefits of this proposal.
Finally, the number of cases chosen is arbitrary, and probably not achievable. Many places with initial success, later failed. Places with heavy lockdowns and severe limitations of economic activity have still seen high case transmission continue despite these measures. Furthermore, having moderate rates of transmission correlates with little, if any excess mortality.
The ultimate fate of COVID-19 is most likely to become seasonal, with iteratively smaller waves. Vaccines will likely get us there faster. A no-more-waves strategy will exacerbate inequality and cause significant health harms; it is an indefensible equation.