Is the worst over? York Region could soon see a 'new normal' after coronavirus

Medical officer addresses questions about Lake Simcoe, trails, vaccines, masks and the ‘second wave’

Yorkregion.com
May 4, 2020
Kim Zarzour

For the first time in a long time, this week’s briefing on COVID-19 in York Region had a tone of optimism.

Dr. Karim Kurji, the region’s medical officer of health, told York Region council that it shouldn’t be long now before we’re back to normal -- albeit a “new normal.”

“I'm feeling fairly optimistic that the worst is over,” Kurji told the April 30 council meeting.

“There is actually a bit of a flattening of the curve … which is really good news.”

He added one caveat: the province has a backlog of 9,000 test results -- about 1,000 of which are likely York Region’s.

Kurji said this will likely lead to a resurgence in cases. He is hopeful, however, that the backlog is due to increased testing and enhanced screening in long-term homes and other facilities.

“We don't really expect to find many asymptomatic individuals in those homes, so I would hope that the numbers increasing will be small.

“But otherwise, this is an excellent picture,” he said, pointing to graphs that show the region appears to be at the peak of the epidemic.

If York continues with the same strategies -- physical distancing and testing -- there should soon be an overall decrease, he said, but until a vaccine or drug is introduced, “I expect sporadic cases and clusters to arise. This will actually be our ‘new normal.’

“Interestingly, the prevalence of influenza has gone down completely and I suspect this is because of the physical distancing. This may be important for us to bear in mind during the next influenza season, we might want to try and use some physical distancing.”

Despite the large number of outbreaks in institutions, Kurji said, there is a plateauing of new cases in these homes, and that, too, is excellent news.

Public health is leading a strategy to provide prevention supports, including expanded testing of staff and residents, assistance with staffing on infection protection and control, and access to personal protective equipment.

“We’ve thrown a lot of our very skilled individuals, the most skilled individuals that we have in the health unit, to tackle all these outbreaks because that is where we have the most vulnerable of our folks and our topmost priority is to save lives. Unfortunately, once the virus has infected individuals, there's not much that we can do.”

“I do expect to see more outbreaks given the widespread testing that we are doing, but I would rather know the extent of the problem and catch it earlier than to find out later.”

Kurji urges the public to make use of York Region's three COVID-19 testing and assessment centers.

Anyone with mild coronavirus-like symptoms -- sore throats, runny nose, headaches, muscle pain, fever, coughing, shortness of breath or diarrhea -- should seek assessment and testing.

This will be particularly important as the province reopens, he said.

“I am quite cognizant of the province wanting to be very careful and asking for two to four weeks of decline in the number of cases. I think that's a wise thing.

“My sense is that the majority of the people in York Region have not been exposed to the virus. Therefore, we have to be very cautious in not allowing the virus the opportunity to again propagate itself.”

So how do you ease into opening while maintaining vigilance?

Kurji said case and contact management and testing will be essential.

“If tests become much more readily available, we’ll be able to get on top of these new cases very quickly.

“We might even consider, like we did with HIV, anonymous testing. People could get themselves tested if they suspect they might have it, making sure they’re not exposing anybody else, and if they test positive, continue isolating. Close contacts as well should isolate and avail themselves of the tests if they were symptomatic.

“There will need to be new strategies. That is the only way in which we can keep society safe."

YORK REGION COUNCILLORS HAVE QUESTIONS FOR DR. KURJI

Q: What's our position on wearing a mask when you're out in public?

A: The jury's still out but it is evolving in favour of use of masks by all, even cloth masks. We will be guided by the federal and provincial health agencies, but there are reports that if there were widespread use of masks -- ideally, surgical masks -- and if physical distancing wasn't being practised to the extent that it is, this would be helpful.

Q: The general public is asking why they are being asked to stay at home when most of the cases are in long-term care or retirement or congregate living.

A: If we were to refer to it as a battle, the front line has changed to congregate living homes. This virus is very, very smart. It appears to find a way of getting from the community into the vulnerable populations.

It is only recently that we have seen a reduction in the community cases. Now the front of the battle has changed to the homes. I would not be too surprised if the virus finds its way into other institutions and other communities that we consider vulnerable.

As we transition to a new normal, we will all need to maintain as much of a physical distance as we can, to carry on with good hand hygiene, disinfecting policies, and cough and sneeze etiquette.

Public health will have to maintain a very high presence with respect to case and contact management and outbreak control. And we hope that the testing will continue to be liberalized. With new technologies, everybody should be able to avail themselves of a test whether they are symptomatic or asymptomatic, as the need arises.

Q: What have you heard about any possible vaccines?

A: We haven't heard anything very positive as yet. There are a number of clinical trials internationally that are being done. It is my sense that we'll probably have a vaccine in nine months to a year, but by the time it actually gets mass produced and administered, we’re looking at another three to six months after that.

More recently in the news is the new antiviral drug remdesivir. I just want to reassure you that our hospitals are also at the leading edge, and in fact, this particular drug has been used on patients many weeks ago through the special access program.

Q: More and more people are going out outdoors on our trails in our parks. Are you satisfied with how municipalities are handling this or is it something you wish we would do better?

A: I'm very happy with the way that municipalities have been handling this. It would appear that the number of cases in the community is going down. I’m quite comfortable with people going out to the trails and getting fresh air. But they must maintain physical distance of six feet until the province relaxes that particular rule.

Q: We are hearing about a second spike in the fall or early winter. What can we do to lessen that or should we be just keeping the lockdown throughout the summer?

A: It isn’t definite that we will get a second wave or third wave, but it has been generally the practice in epidemics. I think we in Ontario will be much better prepared. We've learned a lot of lessons. We've had to become very nimble, had to change our processes on the fly and we now have a tremendous surge capacity to respond very quickly, both in terms of testing as well as protocols for management, so I personally don't think that the second wave will be as challenging.

With respect to continuing the lockdown, health is influenced by social determinants. The economy is also very important. There has to be some sort of balancing act between getting people back to work and yet to be able to contain this virus.

With an extension of good hygiene habits, coupled with as much of physical distancing as we can, and public health response being kept at an elevated level, we should be able to keep this under check until therapeutic interventions (such as a vaccine or treatment modalities) are widely available.

Q: What's your opinion with respect to the recreational use of Lake Simcoe?

A: I would have to be guided by the science. So, in essence, if six feet of distance is being kept, if the groups do not exceed the numbers, one household is not interacting with another household, then that's the way to minimize the risk. But we are not an island unto ourselves. You could be getting people from elsewhere coming to the lake as well and there may be some asymptomatic individuals. So I would be guided by the provincial rules and the province really hasn't made a definitive statement yet.