With coronavirus cases rising in much of Canada, the “circuit-breaker” strategy has become the latest buzzword.
The concept is simple — a set of short, tight restrictions with a deadline, making it more digestible to the public while also helping slow the transmission of the virus, and done quickly, said Dr. Isaac Bogoch, an infectious disease specialist based out of Toronto General Hospital.
“You don’t have the gift of time to introduce — for lack of a better word — more lenient policies,” he said. “It’s basically attempting to put an abrupt halt on transmission.”
For provinces like Alberta, currently seeing a sharp rise in transmission, that strategy is on the table.
Hospitalizations, intensive care patients and deaths have all increased along with cases. The COVID-19 surge has also triggered a domino effect on health resources and staff, forcing the cancellation of elective surgeries in Edmonton for the foreseeable future. All of these are considered warning signs the spread is out of control.
“Clearly a pivot in strategy is needed, so it’s reasonable to discuss a circuit-breaker option,” said Bogoch. “But it’s important to recognize there’s no free lunch. Nothing is going to a perfect solution and every solution will have a detriment to it.”
So, is it a lockdown?
“It’s a time-limited lockdown,” said Dr. Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa. “It’s more of a roller-coaster ride.”
The goal of a circuit breaker is to slow transmission, he said, rather than drive cases down as low as possible. It’s to give contact tracers and health-care systems a chance to catch up, he said.
Unlike a lockdown, the hope is that a circuit-breaker would be a lot less damaging — both to the economy and people’s mental and physical well-being.
Plus, the public buy-in is better, said Deonandan, “since everyone knows that they will be reopening in 14 to 20 days.”
Several European countries have already implemented the strategy, with many being within a two-to-four week range.
Wales just completed a two-week circuit-breaker that required people to remain home with few exceptions. Bars, restaurants and non-essential shops shut and gathering bans, both indoors and out, were imposed. Germany and Northern Ireland both opted for a four-week circuit breaker shutdown with similar restrictions.
Two weeks is the bare minimum duration required, experts agree.
The virus has an incubation period of about 14 days, so anything shorter would risk those infected just before the start of the circuit-breaker still being able to spread it when it ends.
The longer the circuit-breaker, the more likely it would reduce transmission rates, said Bogoch, but the longer it is, the extent of the impact changes too.
“We have to be honest and transparent about what something like this can do, what it can’t do, who’s going to be helped by this, and who may be disproportionately impacted by this,” he said.
“If the pros outweigh the cons in Alberta, then go for it, but we still have to recognize what the cons are.”
Alberta and Manitoba
The biggest factor in Alberta’s consideration is its health-care system.
Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta, said ICUs already run pretty full and that cases have been increasing among people aged between 50 and 70.
Cases will still go up when a circuit-breaker ends, experts agree, but reducing transmission can clear the smoke around where outbreaks are and where they’re going. With “hard and short” restrictions like a circuit-breaker, the aim is to “dial back the clock” for public health, said Saxinger.
“I’m concerned that even the best-case scenario involves a real strain on the health-care system,” she said. “Failure to get things under control quickly could really magnify that.”
The surge in cases led 174 Albertan physicians, including emergency room doctors and infectious disease experts, to write a public letter to the province’s chief medical officer of health, Dr. Deena Hinshaw, saying more needs to be done immediately to prevent hospitals from becoming overwhelmed caring for both COVID-19 cases and other patients. A similar action was taken by doctors in Manitoba.
Should the rate of virus spread continue, the doctors said the consequences to Albertans would be “catastrophic.”
Dr. Darren Markland, a critical care physician in Edmonton who signed the letter, told Global News “it doesn’t feel like anyone’s listening to the people on the front lines about what’s actually happening.”
He said the phased approach to controlling the virus was a valid strategy in the summer when cases and transmission rates were low, “but the balance has tipped.” He grew more concerned when Alberta’s cases overwhelmed its ability to properly contact trace.
“We have a narrow window to be able to deal with this and we can if we shut down again for two weeks,” he said. “It hurts, but every time we get a wave that overwhelms our system, it’s not just the ICU that shuts down, regular hospital care becomes compromised.”
Hinshaw has been considering the circuit-breaker lockdown. She acknowledged the same concerns about well-being, mental health, community and economic impacts.
But Manitoba beat Alberta to it.
On Tuesday, the province reverted to lockdown restrictions. Manitoba currently leads all other provinces in per-capita active cases. Its premier warned the province was nearing a need to hit “the circuit-breaker” last week, and that new restrictions would be “short and sharp,” though there’s no clear deadline for the shutdowns.
“They’re doing the right thing,” said Markland.
But it’s still a last resort for provinces, added Deonandan. “The intent is to buy time,” he said.
How will we know it’s successful?
It’s hard to know definitively if short-stint lockdowns work until after they end.
Wales, which ended its circuit-breaker lockdown on Nov. 9, is starting to see a “leveling off” of COVID-19 case rates. The country’s health minister acknowledged that the full impact of the lockdown would not be seen for at least another two weeks, but that national statistics suggest a “plateauing” or “stabilizing.” Northern Ireland’s and Germany’s are still in progress.
Nevertheless, this is a short-term solution, Bogoch said.
Public health and policymakers need to also think of ways to address drivers of infection, bolster testing and contact tracing, and support communities who might feel the brunt of a circuit-breaker.
“What are your medium and long-term solutions to this?” he asked.
“Those questions have to be asked at the exact same time.”