April 28, 2020

Dr. Bonnie Henry’s most important point today

It was in the Sun‘s lead article today, but it might get missed:

There were just 11 new cases reported between noon Sunday and noon Monday — despite an increase in the amount of testing being done — and no evidence of any transmission on public transit, Henry said.

Two qualifications: (1) Absence of evidence is not evidence of absence.  (2) Over what time did that statement hold true?

Further, has there been any example of community transfer on transit, in Vancouver or elsewhere, and under what circumstances?

It seems obvious on one hand that crowded public transit should facilitate transmission.  But on the other, why aren’t there many more proven examples of it – hotspots in particular – given that some of the places where the virus has been most effectively contained – Taiwan, South Korea, Singapore – have some of the busiest transit systems on which their cities are dependent?   It’s a question that goes hand-in-hand with the density debate, as Sandy discusses in the post below.

If TransLink is to get back to anything like normal service in the next few months, it will depend on the public’s confidence (and willingness to follow protocols) in the safety (or minimal risk) of the transit system.

“No evidence of any transmission” is a very good place to start.

 

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  1. Todd Litman has done some excellent work in this area. His recent article in Planetizen “Lessons from Pandemics: Transportation Risks and Safety Strategies” (https://www.planetizen.com/blogs/109146-lessons-pandemics-transportation-risks-and-safety-strategies) summarizes work to debunk the idea that infectious disease risks make transit dangerous and, by inference, automobile travel safe.

    “Other factors have more effect on pandemic risk….not to deny that public transit can spread infectious diseases…but this research suggests that many other factors have far more effect on individual and community infection rates…well-managed public transit travel is likely to be safer than poorly-managed automobile travel, including all the chauffeured vehicle travel required in sprawled, automobile-dependent communities. “

    1. yes evidence!

      Thee is no evidence of any corona-virus transmission at school (albeit school have kept open in Taiwan)…but there is evidence that domestic violence, from which kids are first victims (with long term consequence), increase with the lock down.

      And still our BC leaders, like in other jurisdiction, are not acting on evidence…but rather on fear, irrational fear one could say (the dire predictions done here and there, including for Sweden, have failed to materialize so far). On the other hand the consequence of over reaction, are well… evident.

      1. Patrick, do you even live in BC?

        By opening their economies, leaders in other jurisdictions are certainly not acting on the evidence. They are either ignoring the evidence for other priorities or they don’t care about it. If we pay attention to covid transmission and death rates across Europe and in New York State, we see how fast things can get out of control, what happens when they do get out of control, and how hard it is to get them back under control. Pure and simple, the “leaders” you are crowing about are gambling with the lives of their citizens, and the odds are not in their favour.

        Today, New York State reached 23,144 Covid deaths. One out of every 847 New York State residents is now dead from Covid, and the pandemic is still humming along. That’s reasonable evidence of what happens when covid is allowed to propagate at a transmission rate greater than 1. If similar numbers started unfolding in BC, would you still be calling for fewer precautions?

        Personally, I prefer to keep our restrictions in place longer while we ramp up testing capacity, contact-tracing capability, PPE supplies, and treatment capabilities. At the same time, let’s observe how other jurisdictions relax their restrictions, learn from what happens when they do relax them, and then follow the best observable models.

        1. Guest a few comments, first and not so important is wiki is showing 17,000 deaths in NY state as of today, it is likely to go up. The next is a question of philosophy, while it is clear that COVID19 is both dangerous and contagious current measures to contain it have costs, not just economic. There are very significant health and wellbeing costs to the measures, many people will die or have shortened lives as a direct or indirect result of these measures (poverty kills). The initial objective was to flatten the curve so the healthcare system is not overwhelmed, measures were taken and in BC and we were successful…but the focus seems to have changed to minimizing COVID19 deaths, this is wrong. COVID deaths are just a portion of total deaths and the measures will increase deaths by other causes over time…..and unless an effective vaccine is developed (far from certain) those deaths are only being moved through time or if they come at a bad time (say the 2nd wave at the same time as flu season, just when people are totally fed up with restrictions and stop listening) they may increase the likelihood we exceed healthcare capacity. Ease up as much as we safely can now and be prepared to reapply measures if they start to climb into the range where the healthcare system is in danger, keep vulnerable populations protected and let the rest of us get it so future waves spread a bit slower (of course if a vaccine comes soon I am wrong but I am not betting on a vaccine). Start with non-emergency surgery, reopening day use and trials in Provincial Parks, school for at least elementary kids (non-manditory) and do it soon.

          1. Rico, I was referring to New York State, but if you like, let’s look at New York City’s numbers as well.

            As of today, New York State has had 23,144 covid deaths, 17,682 of them in New York City. New York State’s population is 19.45 million (2019) and New York City’s is 8.399 million (2018), so the death rate for New York State is approximately 1190 per million (1 out of 847 residents), while death rate for New York City is approximately 2015 per million (1 out of 496 residents). And, for every death, there are many more people who are sick, some of who will only partially recover.

            If things get out of hand here, can our health care system handle those kind of numbers? Ontario and Quebec have had to call in the army to help with the sick and dying.

          2. couldn’t say it better.

            I see many golf courses have reopened, marinas never closed…but hitting the trailhead?

            Guest: “If things get out of hand here, can our health care system handle those kind of numbers?”

            that is called risk management and last time I have checked it was ~100 people for covid-19 in BC hospitals which have ~5,000 beds.

            when the previous government increased the speed limit well aware that could result in increased number of fatalities: it made a risk/reward decision.

            When the current government just reverted the speed limit in some place only, it means he is also comfortable with the current level of fatality on our roads too.

            then is the fatality rate the right metric to carve public policy?
            By that metric the situation is fairly bad in some spot such as NY (and it seems mortality could be 30% higher than reported)…But if the right metric is life-year saving (in cold stat blood: life is priceless but it has a cost and a 20 year old dying in a car crash carry much greater social cost than an elder in a care-home), what seems the metric used in some European state…then we see the things under a different lens and public policy can be calibrated differently.

            the 9th report from the WHO Collaborating Centre for Infectious Disease Modelling, is reputed to have triggered the world lock-down

            In this report there is a graph comparing different policies (page 10) the green is the one somewhat followed by BC and most of the jurisdictions (fewer death in short term, much more in long term), and the orange is the one followed by Sweden (more death in short term, but less in long term).

            Only time will tell which policy was right. but if the report is correct in that instance: the stringent is the current policy, the harder the 2nd wave will be.

            You could gamble on the availability of a vaccine in short time or a tremendous improvement in treatment, but that is also gambling against evidence that the science time is not the same as social acceptance time.

            A bit more on the risk of overwhelming our healthcare system.

            the numbers provided by the above mentioned report, seem disputed: there is both mounting evidence that original numbers with business as usual were over estimated, as well as effect of lock down are also over estimated . A report author, Neil ferguson, explained a couple weeks ago than the UK was on track to contain the number of death under 20,000 …and was promising 1,000,000 for US when Dr. Trump was forecasting 100,000 … another paper published as late as April 15th, “Intervention strategies against COVID-19 and their estimated impact on Swedish healthcare capacity”, predicts Sweden will face 80,000 to 100,000 deaths by June (pretty much like the London Imperial college number)

            …Again time will tell who will be right…and if the economic suicide was justified or not.

  2. In some ways it seems to me to be a little premature to worry about transit while we’re all cooped up. We can’t support it if we can’t use it. Our energies are perhaps better spent on coming to a consensus on when and how we can start taking steps toward normality.

    Between the toll of the virus and the toll of keeping everyone cooped up we’re facing a Sophie’s choice. I don’t think it’s wise to count on a vaccine to save us, partly because of the time it’s likely to take to develop one and partly because of the very real possibility that it will be beyond our abilities to do so for the foreseeable future. So we need to be thinking about ways to ease us out of our lockdown while the virus is still a threat.

    In addition to sound strategies around social distancing, testing and contact tracing, I think it makes a lot of sense for older folks like myself to continue to avoid contact with people as much as possible for as long as possible, even after schools and businesses start to reopen. We’re the folks who have the biggest impact on the health system, and we need to do our part to minimize our burden on it.

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