Michael L.W. Barnes
There was a disturbing blindspot in the 2006 Canadian Pandemic Influenza Plan. It said, “Unfortunately most community-based measures under consideration, including the widespread use of masks, cancellation of public gatherings and closure of schools and businesses, have been anecdotally reported to be ineffective, or their effectiveness has not been formally evaluated.” It recommended that future mathematical modelling be conducted to predict the potential effectiveness of such non-pharmaceutical interventions (NPIs).
Even then, I was convinced that community-based measures would be highly effective, and in December 2006 I found an interesting article in the Royal Society’s peer-reviewed journal Interface that used mathematical modelling to show the likely effectiveness of a variety of NPIs in mitigating a future influenza pandemic in the USA, UK and Netherlands.
The three distinguished researchers who wrote that Interface article, when I reached them, agreed to volunteer and evaluate the potential impact of non-pharmaceutical interventions (NPIs) not emphasized in the 2006 Canadian plan. They were Abba Gumel, Ph.D., Professor of Mathematics, University of Manitoba; Miriam Nuño, Ph.D., Department of Biostatistics, Harvard School of Public Health and Gerardo Chowell, Ph.D., Mathematical Modeling and Analysis Group, Los Alamos National Laboratory. They provided their research as a free public service for Canadians.
That report appeared in the Canadian Journal of Infectious Diseases and Medical Microbiology in March 2008. It found that NPIs can drastically reduce the burden of a pandemic in Canada. Their research provided mathematical proof that early use of NPIs in a severe pandemic could be effective—and it was published 15 months before the H1N1 influenza pandemic. Dr. Abba Gumel, the lead author, went on to win the 2009 Dr. Lindsay E. Nicolle Award for this significant contribution to the field of infectious disease, as demonstrated by the impact of original research published in that journal.
When I told the researchers that my federal department employer would not permit them to acknowledge my role in launching and commenting on their report, they chose to mask that acknowledgement by changing the article’s opening paragraph to, “The main motivation of the present study stems from the encouragement we received from some government officials in Canada, to extend the earlier work on the analysis of the pandemic influenza preparedness plans to the United Kingdom (UK), the United States (US) and the Netherlands, and to assess the Canadian pandemic influenza preparedness plan. Canada, like many other nations, has formulated its pandemic preparedness plan in anticipation of a potential pandemic.”
I was concerned that Canada seemed to be overlooking critical tools needed to respond effectively to a severe pandemic. As an economist I felt that not using NPIs early and boldly in a severe pandemic would result in many more illnesses, hospitalizations and deaths. At some point, the health systems in severely affected regions might falter, if not fail.
Even today, the current Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (August 2018) states, “While aggressive measures (e.g., widespread antiviral use and restriction of movement) to attempt to contain or slow an emerging pandemic in its earliest stages were previously considered possible on the basis of modeling, experience from the 2009 pandemic has resulted in general agreement that such attempts are impractical, if not impossible.” Yet Mexican H1N1 influenza pandemic data from 2009 showed an 18-day period of mandatory school closures and other social distancing measures reduced influenza transmission by 29% to 37% in the Mexico City area. Furthermore, hospitalization rates fell from about 70% to 10% during the period when schools were closed and other NPIs were enacted. So actual H1N1 pandemic data demonstrates these measures can limit transmissions and reduce hospitalizations.
The next Canadian Pandemic Plan should recognize NPIs, as suggested since 2008, as effective ways to reduce illness, hospitalizations and deaths, especially when there are no effective therapies and vaccines at the outset of severe pandemics.
NPIs continue to be used in Canada and around the world to reduce COVID-19 transmission and more. Down the road, a vast amount of COVID-19 data will demonstrate the effectiveness of NPIs. Many lessons will be learnt from NPI use during this pandemic and many opportunities to refine and improve the future use of NPIs based on health, societal and economic reasons. But for now, I am glad that those three researchers had the foresight to study and confirm the vital role these public health measures play in “flattening the curve.”
A closing point: all Canadian jurisdictions should look to Vietnam, a developing country, who acted early and applied NPIs vigorously. At the time of writing, with 97 million people, Vietnam has had just 328 COVID-19 cases and zero deaths.