With 74 confirmed active cases of COVID-19 in Ontario, the province is preparing for a larger outbreak — and Ontarians are left to wonder how best to protect themselves and their communities.
Kieran Moore has been helping Ontario plan for the coronavirus since late last year. The medical officer of health for Kingston, Frontenac, Lennox, and Addington, he’s been working in health care and outbreak detection for more than 35 years.
TVO.org spoke with Moore on Thursday afternoon about the province’s response and what precautions Ontarians should be taking.
TVO.org: How would you categorize the province’s response thus far?
Kieran Moore: I think it’s been appropriate to the risk. We have all ramped up. I think it’s fair to say that the Ontario system is at 100 per cent occupancy right now, and our main goal from a public-health vantage point is to preserve and protect our health-care system so that it can continue to provide the acute-care services that it’s required to. So, as compared to other jurisdictions, we may have to dampen down the spread very, very quickly through broad social measures. I think we’ll hear over the next couple of days the broad social-isolation measures that we’ll have to put in place at a government level. Quebec just said that any returning traveller has to stay home for 14 days, and that’s from anywhere on the globe. Those sorts of measures are warranted. I am a little bit concerned with March break and members of our community, through no fault of their own, bringing the respiratory illness home with them.
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TVO.org: Just minutes ago, Ontario announced it will close elementary and secondary schools for two weeks after March break. Is that sort of action appropriate?
Moore: Absolutely, it’s appropriate. The last thing we need — we potentially have some propagation of the virus in Toronto; that’s getting investigated — we don’t need any returning travellers causing a significant rise in case counts across Ontario. That level of closure, which is more than one incubation period, is very reasonable to protect our communities. Not that children get ill — from our review, they get mild symptoms, or very few symptoms — but they can spread it back to their parents or to vulnerable people, such as the elderly. I know it’s going to cause disruption, but this is the price as a community we have to pay.
TVO.org: March 12 marked the province’s largest increase in cases so far. Will Ontarians have to get used to this?
Moore: I think we’re going to have to get used to this. A normal influenza season lasts six to eight weeks at its peak and can go on for three months. What we’re trying to do with coronavirus, with COVID-19, is to limit the spread. You never get rid of the threat. You could potentially make these public-health decisions last longer, but these are the decisions we have to make as a society. We don’t want to be too coercive, but we do want to balance our response. It is, apparently, spreading in warmer climates, down in Australia and elsewhere, and we don’t know if this will continue through the summer or if we’ll get a slight break and have to prepare for the winter. So this is going to be a year or two where we’ll be putting out small little flames to prevent a major fire of infection in our communities.
TVO.org: How does the response here compare to other countries that are ahead of us in the outbreak timeline?
Moore: I would hope that we would be comparable to how [South] Korea has responded. Korea has expanded its lab-testing capacity — and we have a very high functioning Public Health Ontario lab system — they have been able to test many, many people in their community and also have appropriate settings for at-risk individuals as they enter the hospital system. That early identification of cases and quarantining of contacts are our only major tools. The countries that have failed haven’t had good testing initially, haven’t implemented it rapidly, and haven’t implemented social isolation rules early. So, Italy didn’t know it was spreading for many weeks; the United States didn’t know it was spreading for many weeks. But we had higher testing levels than the United States did on a per capita basis, and we have been testing since the beginning of this. So I am confident that we’re not missing any significant community spread at this time.
TVO.org: You mentioned the U.S. How much of our fate depends on its ability to deal with its own outbreak?
Moore: Oh, a big part. To stop transportation, or to stop our citizens from travelling to the United States, will have social disruption, but we may have to get to that point if there are significant hot spots. We could do it in a targeted way — if Seattle heats up, maybe we’re more conscious of the Vancouver-Washington border. We can do it in a targeted fashion. The main differences I see in the United States is that they haven’t had the same testing capacity; they have a fractured, cost-driven health-care system that is not universal, and, because of the lack of access to health care and the costs associated with it, individuals won’t get tested, and it will spread in their communities. I am so thankful for our public-health system that doesn’t have significant barriers to access. And, so, people are coming forward, there’s not a cost to get tested, and they’re behaving in a socially conscientious way.
TVO.org: How would you compare the risk and response levels between Ontario’s largest centres, such as Toronto and Ottawa, and its smaller centres, such as Kingston, or even rural Ontario?
Moore: The good news is we’ve been working with five divisions across the province called Ontario Health, and each has a director coordinating the health-care response across Ontario; as well, the 34 health units have regular teleconferences to show we’re all approaching this in a consistent fashion. We can all approach Public Health Ontario for scientific advice; we can all seek guidance from the ministry if we’re having increased rates of disease in our area. I’m pretty happy at present with the enhanced communication — and I’ve worked in the health system for 35 years.
TVO.org: On a more individual level, a lot of Ontarians don’t know whether they should stock up on prescription medication, toilet paper, or whatever else. What is a reasonable response right now?
Moore: If you have a health problem, you should make sure 14 days of medicine is available to you. Please make sure you have repeats. If your underlying health issue exacerbates, you may not want to visit a health-care provider, so you should have an action plan for how to modify your medication if required and have someone to call for guidance in case you don’t want to go to a health-care system. You should have appropriate foods in place for roughly 14 days. You should have appropriate hygiene available to clean surfaces, to help if you develop respiratory symptoms — so tissues and basic medicines like something to control a fever and body aches. But we also have to be conscientious, and you don’t need buckets of toilet paper at home. We all have to be reasonable. We’ll get through this, and we’ll get through this together, but hoarding is unnecessary.
We’re also suggesting that now is one of the best times to quit smoking. We still have 15 to 18 per cent of Ontarians that smoke and, in our opinion, smoke will inhibit your ability to respond well to any virus and probably coronavirus, too. So there’s no better time to quit than now. So if you’re looking for actions to take now: if you have any underlying chronic disease, make sure it’s stabilized now; if you’re a smoker, try to quit; and if you’re finding stress, a half-hour walk a day will help your heart and lungs and help burn off some of that stress and anxiety.
TVO.org: How has your life changed since the outbreak of the coronavirus?
Moore: We were monitoring this from late December. We had been getting ministry letters and emails, and they had been monitoring this really closely. As soon as we started to see the numbers go up in Wuhan and Hubei, we went into what’s called an incident-management system, where three times a week we monitored the situation to see if it would have an impact on Canada, on travel, and so on. We did that quite early, so we were prepared early, and we communicated fairly early with all our major partners, from a public-health vantage point.
TVO.org: You sound quite confident. Is that fair?
Moore: Yeah, I think it is fair to say that we’ve got plenty of experience. I’ve been around for a while now. We worked through SARS; we worked through H1N1. To be honest, this is like a severe influenza season, except that we don’t have all the traditional tools to respond to it. We’re used to dealing with respiratory outbreaks in the community, whether it be in long-term care or in the hospital sector — it’s just that some of our traditional tools like a vaccine or anti-viral are missing.
TVO.org: Has having an intimate knowledge of the challenges we face and how we’re handling them helped or hurt your own personal anxiety levels?
Moore: I’m a little anxious now because I’m trying to prepare our health system. There are a lot of things to do: I have to work with police, ambulance, primary care, hospitals, school boards, cities, colleges and universities. Events like St. Paddy’s Day are coming up. And I want to ensure the balance of providing good information to the public but not causing too much concern. So that’s my anxiety. I’m not worried about the virus itself. Looking at the numbers out of Korea, only a few are actually at risk, and that’s typically the elderly. And that’s where we really, as a community, have to be really conscientious: this can cause death in the elderly, especially if you’re over 80.
TVO.org: But in long-term care, social connections are so important. Is there a way to balance what feels like two competing priorities?
Moore: There absolutely is. If you’re the one who has the acute respiratory infection, or who has travelled, don’t go. But if another of your family members has been well and has not travelled and has no issues, I mean, this is just two weeks we’re asking you not to visit. My father, when he was 92, was still on the computer every day, still had an iPad, and we communicated with him electronically. I think maintaining connection is important, but now that we have so many alternate means to do it, I would ask that we use those electronic means. A responsible, prudent person wouldn’t go if they’ve travelled in the last 14 days or had a respiratory infection in the last 14 days. But, absolutely, keep the social connectedness up.
TVO.org: Lastly, is there anything we’re missing in this conversation that we need to talk about?
Moore: From my vantage point, there are a lot of lessons learned from previous outbreaks and previous stresses to the health care system. It’s too bad we don’t have Ontario Health teams in place across Ontario — it would have been way easier to coordinate primary care, because getting all our primary health partners together and to work consistently together … you know, this type of work on response to Covid-19 could be what’s necessary to bring these teams and let them gel. But, in many areas across the province, they’re still in their infancy.
So, when we reflect a year or two from now, we’ll say that better partnerships with primary care, with acute-care partners, and with public health will be essential, and we have to support our primary-care partners more effectively. Many can’t even swab right now — they don’t have adequate infection prevention and control. The solo practices can’t afford that kind of equipment. I can see, down the road, we’re going to need more groups of primary-care physicians working more effectively together. If primary care were a more integrated partner in the planning and response, it would make everyone’s life easier.
This interview has been condensed and edited for length and clarity.
This is one in a series of stories about issues affecting eastern Ontario. It's brought to you with the assistance of Queen’s University.
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