Covid Alert, Covid-19, Ontario, Public health, Toronto

Moving from aspirational to effective contact tracing

How many times have we heard the tune “Shoppers Drug Mart employee test positive for Covid-19 in the Junction”? What are we supposed to do with this information other than sharing it on Facebook hoping your friends who shop at that location are notified. But even if they are informed questions are raised. Which employee tested positive? Because if it was an employee solely moving boxes in storage the clients may not have much to worry about, but if it was someone working as cashier many clients would have been exposed. In summary, the problem with this scenario is that it is aspirational contact tracing. And it fails to answer a key question: how did that employee contract the virus?

https://dailyhive.com/toronto/shoppers-drug-mart-covid-19-december-18

Ideally, everyone who was in the building between the hours the employee worked should be notified of potential exposure. The Covid Alert app could help, but it would require that the employee who tested positive and those exposed have the app running on their smartphones. And since its adoption is voluntary and requires a newer smartphone not everyone has it. Hence this remarkable app should be seen as one of many ways to combat the pandemic and not a silver bullet.

As a Canadian who grew up abroad and has backpacked around our beautiful globe, I tend to ask myself: what else are other countries doing to solve this problem, which by now has affected every corner of the earth. 

Quick Response (QR) codes are effectively being used for contact tracing by businesses in Asia, Europe, and Oceania:

https://esnetwork.ca/briefings/qr-codes-as-an-approach-to-contact-tracing-for-covid-19/

On the local scene, a Canadian company has developed a QR code contact tracing solution to help businesses:

Based on the above study, QR code contact tracing solutions work best when managed by service providers for a specific transaction, for example, a movie night. So when you enter the theatre you would present your tickets and scan a QR code with your smartphone. Cineplex will not get your contact details, all they will see is a randomly generated identification code e.g. UserElVez has entered the theatre. Employees would scan the QR code when their shift begins. So, If Employee007 who later tests positive was working when UserElVez was in the theatre UserElVez would be automatically and confidentially notified of potential exposure. Naturally, all clients and employees who were in the theatre at the same time as Employee007 would also be notified. Since the movie is 2 hours long the system would automatically know when UserElVez left the building. 

Finding out how Employee007 contracted Covid might be best left to contact tracing professionals working for local public health units. However, notifying who may have been exposed by Employee007 at work to Covid can be automatically done by QR code systems, thus allowing contact tracers who are already overworked to focus on other critical matters.

QR code contact tracing is far superior to pen and paper which restaurants in T.O. were using in the summer for contact tracing since pen and paper can easily lead to privacy breaches. It is positive to see many local businesses adopt QR code solutions, but to be truly effective widespread adoption is needed. Here is a situation where local governments can take the lead and encourage the use of QR code contact tracing.

QR code contact tracing is more effective and secure than pen and pencil.
Covid-19, Ontario, Parkdale - High Park, Public health, Public safety, Toronto

Close big-box stores

The frustration of businesses that had to close in-store shopping when Toronto went into the “Grey-lockdown zone”, while their competitor big box stores remained open, is completely understandable. Premier Ford rationalized that it would be difficult for these big stores to close their toy departments and only sell groceries. While I completely disagree with the Premier (room dividers were invented centuries ago) and agree with businesses that were forced to close that there is an unfairness to these measures, the key problem is that we still haven’t flattened the curve.

Let’s face reality, at the beginning of the pandemic we had a contact tracing system in Ontario that relied on fax machines and manual entry. The new system is better, but we are way behind Korea and Taiwan who have taken contact tracing to a state of the art. This means until a significant amount of our population has been vaccinated our best remedy is asking businesses to close their doors to save lives and protect public health.

Recently, Canadian Appliance Source (CAS) wanted to remain open to customers shopping at their stores, but lost a decision, in part because the judge correctly noted that they are not a hardware store and therefore not exempt from the lockdown. Below is an insightful statement from this case:

Cdn Appliance made forceful arguments that as an appliance supplier, it is an essential service business; visualize: who’s to say that during a pandemic that a washing machine that cleans clothes or a refrigerator that preserves food is less essential than a hammer? https://www.canlii.org/en/on/onsc/doc/2020/2020onsc7665/2020onsc7665.html

Last spring, during the height of the first wave our washer-dryer unit broke down and the repair person said it was cheaper to buy a new one. I called CAS and fortunately was able to order a new unit and have it installed in just a couple of days. CAS is right in saying that an appliance is no less essential than hardware. Having a working washer-dryer unit means we can stay home, not go out to the laundromat, and thus avoid potential exposure to the virus. It is not ideal to buy online or over the phone. Certainly, I would have liked to have seen the unit in person first, but these certainly aren’t ideal times. The court case exposed the contradictions in the recent “lockdown”. However, since hammers and washing machines can both be bought over the phone or online, shouldn’t hardware stores close their doors too?

This second wave is worse than the first one. So we have to ask ourselves if a business can sell their products and services over the phone or online then maybe that business must be closed to in-store shopping during this second surge. The big-box stores have the IT infrastructure to sell by phone and online. They also have the means to afford a temporary closure of their stores. Big box stores must close their doors too.

If a refrigerator that preserves food is just as essential as duct tape, why are hardware stores open and appliance stores closed?
Covid-19, Ontario, Parkdale - High Park, Public health, Public safety, Toronto

Restaurant patio tents must have at least two full sides open

By now you likely know that “the data available so far indicate that indoor transmission of the virus far outstrips outdoor transmission.” Which is a key reason why outdoor dining is safer than indoor dining. As the weather has become colder in Toronto, we have seen patio tents in restaurants become ubiquitous. Which raises the question: at what point does dining in an enclosed tent become as risky as dining indoors?

What does the law say? First, let’s look at the CaféTo guidelines.  Which state:

A tent/structure may be permitted on private property if the following requirements are met:

  • An area that is covered by a roof, canopy, tent, awning or other element, must have at least two full sides open to the outdoors and cannot not be blocked by other walls or physical…

Some might argue that this requirement is just a guideline. However, Ontario Regulation 263/20 RULES FOR AREAS IN STAGE 2 mirrors the above guidelines and states in Schedule 2:

12.  If an outdoor dining area at the establishment is covered by a roof, canopy, tent, awning or other element, at least two full sides of the entire outdoor dining area must be open to the outdoors and must not be substantially blocked by any walls or other impermeable physical barriers.

13.  If an outdoor dining area at the establishment is equipped with a retractable roof and the roof is retracted, at least one full side of the outdoor dining area must be open to the outdoors and must not be substantially blocked by any walls or other impermeable physical barriers.

Based on the above it is a legal requirement for restaurant patio tents to have two full sides open to the outdoors. The purpose of this requirement is to increase outdoor airflow and thus reduce the risk of Covid transmission.

What happens if you see a restaurant that is not in compliance with this requirement e.g. a completely enclosed tent with customers inside? You may want to heed the purpose of this requirement and not dine there due to the risks. If you know the owner, you might want to inform them about these requirements. You also can contact 311 to inform the City of potential noncompliance.

Restaurant workers and owners have been hard hit during this pandemic. I admire their resolve in face of trouble and their use of patio tents to save their jobs and business. As the weather becomes colder there might be a temptation to close the tents i.e. not have at least two full sides open. However, these rules are there to protect us. While there is a case that all levels of government might not be doing enough to help the restaurant industry, that is still no excuse for not complying with regulations that protect safety.

Restaurant patio tents must have at least two full sides open
Covid Alert, Covid-19, Ontario, Public health, Toronto

Covid Alert prevents further infections

The cancellation of a curling event in Waterloo after a player was notified by the Covid Alert app that they had contact with a person who tested positive for Covid-19 is a win for the hard-working team that developed this app. A win because this cancellation is a case study of exactly how the app should work.

Imagine we did not have the Covid Alert app and the player was infected. The player could transmit the virus to the other players, the players could transmit the virus to patrons and employees at their local pub, the patrons and employees could transmit the virus to their partners who teach at the local school, and the teachers could transmit the virus to students and other teachers. The curling event would be a bubble connected to the pub’s bubble, which in turn is connected to the school’s bubble. And without Covid Alert we could have had yet another dreaded super spreader event. However, what Covid Alert achieved was to separate the curling event, the pub, and the school into separate bubbles.

Hopefully, the player will not test positive. However, close contact presents a risk which the event organizers did not want to take. Kudos to them for showing a level of responsibility commensurate with the potential gravity of the circumstances. Perhaps they adverted several infections in great part thanks to the Covid Alert app. Certainly, the event organizers have set an example in caring for the safety of their community.

The news is bad these days. Ontario is in a second wave, the contact tracing team in Toronto is overwhelmed, but we can still take positive action: please download the Covid Alert app today. It works.

Covid Alert prevents further infections
Covid Alert, Covid-19, Public health, Toronto

Covid Hotspots in T.O.

Last month, we saw two trends in T.O.:

This week we are seeing a familiar and sad pattern, new cases are concentrated in North Etobicoke and North Scarborough. For example, the postal code M9R in North Etobicoke has had 66 reported cases since August 1, 2020. In contrast, postal codes in Central Toronto are in the single digits for the same timeframe.

We have heard that density is one possible reason why there are Covid hotspots in Toronto. However, when we see far more dense cities like Taipei having defeated Covid, we quickly realize that density is not an excuse.

Certainly, there is a link between Covid cases and income. However, we have the means to help North Etobicoke and North Scarborough. Consequently, we should act by demanding the following from our governments:

Together we have managed to slow the spread of Covid down significantly, together we can defeat it.

Covid cases by postal code T.O.
Covid-19, Public health, Toronto

People under 40 account for 65% of recent Covid cases in T.O.

First, here is the good news: back in late July and early August we saw daily reported Covid cases in T.O. drop to the single digits. Furthermore, so far in August, we have been averaging about 18 new cases a day. Now for some disconcerting news, residents under 40 make up 65 % of the cases seen in August, in other words, two thirds.

It might be easy to imagine crowded indoor bars full of young people not wearing masks and thereby pass judgement. However, we all know that several essential workers are under 40. So, it is not clear what is causing this discrepancy between age groups.

Faced with this uncertainty, perhaps the best course of action is education, such as Dr. Eileen de Villa’s recent announcement. Villa reminds us that despite some encouraging numbers we must all remain vigilant as we enter Stage 3. Otherwise, the consequences can be a second wave of Covid.

One key lesson these statistics teach us is that youth does not mean immunity. The fact that in 2 out of 3 cases the person is under 40 means that we all must be careful, regardless of age.

Under40
Daily Covid T.O. cases in August 2020

Covid-19, Ontario, Public health, Public safety, Toronto

Covid transmission indoors

In early 2020 there was a Covid outbreak in an air-conditioned restaurant in Guangzhou, China. A study about this specific outbreak concluded that,“droplet transmission was prompted by air-conditioned ventilation.” A subsequent study recommended avoiding re-circulated air and maximizing outdoor air supply in buildings. Then the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) produced a guidance document for re-opening schools and universities.  However, one key fact remains: there is less risk of Covid transmission outdoors than indoors.

We can safely conclude that there is less risk outdoors, because most Covid transmissions have taken place indoors, and there has only been a limited number of outdoor transmission cases, as per Ian Hanomansing’s informative tweet.

This knowledge should be driving our public policy. Specifically, in the following areas:

  • University and school classes need to be outdoors (weather permitting) or better yet completely online,
  • Bars and restaurants need to have open windows or preferably patio seating, and
  • Employers may need to upgrade their ventilation systems and implement engineering controls.

On a personal note, it was sad to see Brothers Food & Wine permanently closed. I have wonderful memories of spending time there with family. However, it was admirable to see the owners of Brothers recognize that it would not be responsible to reopen a locale which did not lend itself to physical distancing.

Likewise, we must all do our part during this pandemic and whenever possible take our activities outdoors. If outdoors is not an option nor is staying at home, employers and educational institutions must rely on professional advice to implement risk mitigation measures, such as engineering controls, personal protection equipment, physical distancing and upgrading of ventilation systems.

brothers
Brothers Food & Wine is now permanently closed.

Covid-19, Mental health, Parkdale - High Park, Public health, Toronto, Ward 4

Mental Health Resources at Parkdale – High Park

While we focus on bringing Covid cases down, let’s not lose sight of mental health, which is equally important as our physical health. Layoffs, lack of social interaction, financial difficulties, strained relationships, and uncertainty have consequences. So, during these difficult times it is only natural to seek help. On that note, here are some mental health resources for those living in the Parkdale – High Park area:

Finally, some insurance plans cover counselling and psychotherapy services. Laid off employees part of a group plan may still qualify for these benefits. For information contact the insurance provider.

In the event of an emergency one should always call 911.

4villages

 

Covid Alert, Covid-19, Ontario, Public health, Public safety, Toronto

The case for Canada’s Covid Alert app

There are five reasons why we should all be optimistic about Canada’s new Covid Alert app:

  1. An Oxford study indicates that Contact Tracing apps have the potential to significantly reduce Covid transmission (noting that half of transmission cases occurred before symptoms were present);
  2. Both, Korea and Taiwan have implemented highly successful Contact Tracing apps;
  3. The low level of virus exposure notifications by some European Contact Tracing apps can be explained by the fact that social distancing measures are still in effect and these apps are still in the early stages of adoption;
  4. The Bluetooth technology used to determine “close contact” might be new, but is continuously improving; and
  5. Apple and Google, which developed the Application Programming Interface (API) used by Covid Alert, prioritized privacy.

Critics of the new app are correct to point out that many essential workers and retired folks might not be able to afford a smartphone to run this app. Nonetheless, these problems can be resolved by implementing new laws requiring employers to provide smartphones to essential workers, just like they are required to provide them with Personal Protection Equipment (PPE). Furthermore, governments should strongly consider providing free smartphones to seniors and anyone who cannot afford them in their efforts to turn the tide against Covid.

Engineers, scientists, and those working with new technologies understand that no innovation is perfect from the get-go. In fact, several iterations may be required to have a successful Covid Alert program. It is not in our spirit to give up when the going gets tough. Otherwise, Canadians would not have invented the electric wheelchair, the pacemaker, or the telephone just to name a few of our innovations.

This blog post is a call to all engineers, programmers, scientists, technologists, and innovation enthusiasts in Ontario to download the Covid Alert app today, and to please help your co-workers, family and friends install it as well. The science says Contact Tracing apps have the potential to significantly reduce Covid transmission. Now it is our turn to use Covid Alert, help improve it, and do what we do best which is to protect the public.

CovidAlert

Covid-19, Public health, Public safety, Toronto, Uncategorized

Preventing a second wave of Covid in T.O.

After months of mostly bad news, the latest Covid figures from Open Data Toronto give us some reasons to be hopeful. In fact, the past two days, we have seen the lowest numbers of daily Covid cases since the start of the pandemic. As relieved as this data might make us feel, it is important to note that the struggle to put an end to Covid in T.O. is not over. Which means that prevention measures, such as: frequent hand washing, physical distancing, staying home if possible, and wearing face masks need to continue for the foreseeable future to avert a second wave.

Furthermore, it was encouraging, but not surprising to see the total number of daily cases drop even further after the TTC and the City made face coverings mandatory. Most notably, daily sporadic cases (i.e. not associated with an outbreak) have been in the single digits the past two days. While there are a number of factors that contributed to this drop, the science is crystal clear, face masks help reduce contagion: https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent

While some of us might oppose wearing face masks, as a community we are better off when we follow the advice of professionals and the latest science, especially on matters concerning public health and safety.

Together we have managed to lower the number of Covid daily cases in T.O. significantly. However, we need to be aware that other cities, which achieved similar success and rushed to lift restrictions (without implementing reasonable mitigation measures), later found themselves facing a second wave, and consequently had to shut down their economy once more. Until there is a vaccine, or an effective treatment, or a new technology that prevents transmission in a significant way, at least for now, the best methods we have for reducing Covid cases are: frequent handwashing, engaging in physical distancing, studying or working from home (when possible), and wearing a face mask (especially when indoors).

We The North can enjoy the outdoors (e.g. parks and patios) with a warm jacket in the Fall and even Winter, so even though restrictions will be lifted soon, there should be no reason to go to indoor spaces known for their risk of outbreaks (e.g. crowded bars, large parties or packed restaurants). Stay safe and stay hopeful.

Sporadic