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What lies on the road ahead with COVID-19?

Updated questions and answers with epidemiologist Dr. Emma Bartfay of Ontario Tech’s Faculty of Health Sciences

Epidemiologist Dr. Emma Bartfay is a Professor with Ontario Tech University's Faculty of Health Sciences.
Epidemiologist Dr. Emma Bartfay is a Professor with Ontario Tech University's Faculty of Health Sciences.

Ontario Tech University epidemiologist Dr. Emma Bartfay continues to monitor local, national and global developments with the COVID-19 pandemic. The Faculty of Health Sciences researcher offers her take on the latest developments:

Most jurisdictions are now at varying stages of reopening. Do you think the lockdown effort has accomplished its goal?

“I am glad to see the world is starting to re-open. Wrapping ourselves up like we did could never be a long-term solution to any pandemics. People are really itching to come out. We all saw what happened at Trinity Bellwoods Park. But I am not completely convinced that it’s really accomplished as much as officials are telling us. The collateral damage has been huge. For two months, we turned people’s entire livelihood upside down, socially, mentally and financially. We kept hearing the message that we must stay indoors to save lives and stay healthy. Conveying these messages was done so well that many people are absolutely terrified of the disease. Their level of anxiety and fear is almost irrational and is disproportionate to the level of threat from COVID-19. Are we having a crisis? Yes, definitely. Are there vulnerable people with increased risk of dying? You bet.

Being healthy is more than the absence of an illness; it is also about our mental and social well-being. At times, I feel the government is pitting the situation between saving lives and saving the economy, or that we are somehow vilified if we speak up for the latter.

But from my perspective, this is not just about money. Like many countries around the world, our Canadian government is also spending a massive amount of money to provide financial aid to its citizens. But is it the best approach to deal with the problem? If you look at the big picture, COVID-19 did not affect every segment of the society equally. The majority of the deaths have occurred at long-term care facilities. Could we have used the money—this massive amount of money—in a different way that targets where it is needed most? Could we have prioritized our resources to these facilities and seen a different outcome while keeping the rest of the society intact?”

What is the biggest concern of reopening?

“One of the biggest concerns of re-opening society is the possibility of a spike in the number of cases. We call these spikes ‘waves’. Second waves, and even third waves, are common with pandemics.

I would not be surprised to see the number of cases increase again. But we shouldn’t be worrying too much about this specific number. The vast majority of the cases are mild. What we should be concerned with is the proportion of deaths and serious cases.

Now that we know which sub-population(s) are at particularly high risk of dying and other serious consequences of COVID-19, we should be able to prioritize our efforts to prevent future cases in these environments.” 

What else can we do to lower the risk of future waves in the general public?

“Since COVID-19 is transmitted from person-to-person, restricting interactions among people would certainly help. Everyone has a role to play. The public can continue to keep a physical distance from one another, practice hand and sneeze hygiene. But the government must also continue to be vigilant with critical public-health measures including case finding and contact tracing. These tactics are classic public-health approaches with proven results. They’ve been used for many communicable diseases including sexually transmitted infections, and well-publicized epidemics such as Severe Acute Respiratory Syndrome (SARS) and Ebola. Aggressive contact tracing was credited for containing SARS quickly.”

Are case finding and contact tracing the answers to minimizing a second or third wave?

“Fighting a pandemic is about stopping transmission, until there are no more cases, or the number of cases becomes manageable. Case finding and contact tracing interfere with transmission. When you can isolate an infected person from the community, they cannot transmit the virus. It is like breaking a chain: when you remove a link, the chain breaks.

But contact tracing is very labour-intensive and offers the biggest impact when the number of cases is relatively small. And it also must be used alongside other strategies, like case finding, testing and quarantine.

Mobile apps that use GPS or Bluetooth technology can also be deployed. While some argue this is a more efficient way to track potential cases, this technology relies heavily on the public’s acceptance and self-initiative. Privacy is another issue. How much personal information are you willing to give up, and what do you do with the collected data after the pandemic is over?”

Will COVID-19 change how we react to future pandemics?

“Many say ‘lives will never be the same’ or that there will be a ‘new normal’ after COVID-19. I am not so sure. Certainly there will be heightened awareness of personal and hand hygiene. Hand sanitizers will be more readily available in public places. But after a while, people will become complacent and forget. In many ways it’s human nature, and we do have a very short attention span nowadays.

Let’s use SARS in 2003 as an example. Toronto was the most affected city outside of Asia. There was plenty of pandemic preparedness. The World Health Organization praised Toronto for its post-SARS plan.

Then our focus fades as time passes. After SARS, there was supposedly a stockpile of PPE. But when the equipment’s best-before date expired, it was not replaced. Nothing happened for years, and people moved on to other things. SARS was supposed to be a wakeup call. COVID-19 told us that we are still sleeping.

Speaking of SARS, are there any distinctions between COVID-19 and SARS back in 2003?

“One of the biggest differences is the vast amount of information, and misinformation that circulates online, in mainstream and social media. It is called ‘infodemics.’ With previous pandemics, the public never had access to so much (mis)information; this time, I think it led to a level of unprecedented public anxiety and panic, such as the inexplicable hoarding of items like toilet paper. Future pandemic preparedness plans need to flexible and sustainable for the long-term. And yes, we need to find strategies to deal with the enormous problem of misinformation.”

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Bryan Oliver
Communications and Marketing
Ontario Tech University