'There's no playbook' for easing physical distancing amid COVID-19 pandemic, doctor says

Public health experts in Ontario said this week that community spread of the novel coronavirus appears to be slowing down — leaving many wondering what that may mean for the physical distancing measures in place to contain the COVID-19 outbreak.

On Tuesday, CBC Radio's Metro Morning asked Dr. Isaac Bogoch, an infectious disease specialist and researcher based at Toronto General Hospital, about the weeks and months ahead and what kind of social activities might be allowed to restart.

Bogoch (IB) spoke to guest host David Common (DC). The interview has been lightly edited for clarity and length.

DC: How do we continue to save lives by limiting the spread of COVID-19 while slowly trying to get back to a degree of normalcy?

IB: That's going to be the hard part and I really hope that the policy makers have given this a tremendous amount of thought. Interestingly, there's no playbook, right? This is the first time anyone has done this since 1917 or 1918. We can look at other countries and what other countries have done, but really those places are only two or three months ahead of us. I appreciate that the general principles are the same, and we can use the big terms like 'open up slowly', 'be careful about congregation', 'ensure access to hand hygiene', 'ensure we can still maintain some physical distancing.' We can all talk about the same big picture issues, but when we get down to the details of who is allowed to open, where are we allowed to go, what are we allowed to do and how do we shift through different phases of this, that's pretty tricky and I think it's going to be rather context specific. So what's true for Toronto or Ontario may not be true for the rest of Canada, which may not be true for other places that are going through this.

DC: Let's talk about the GTA here for a moment. We have a diverse population that travels a fair bit, we're a major travel hub, there is density of population. When you look at certain things like places we might gather, whether it's concerts or restaurants,  are those sorts of things going to be pushed later in terms of what might be allowed?

IB: I can't see large gatherings happening any time soon.

DC: What is "any time soon"? Are we talking about months and months and months?

IB: Yeah. We're really talking about the pre-vaccine era, which can be quite a while. If we still have this virus circulating and we don't have an effective way to prevent it, it's hard to think about having 20,000 people under one roof. I just don't know how that can happen safely. But you can envision starting up things like professional sports with empty stadiums. You can think about loosening some restrictions on some places. And again I'm just getting creative here, I don't have any inside information, but could restaurants open but seat 25 per cent capacity, ensuring that there is appropriate hand sanitizer and space between tables? I'm sure there are creative ways to do this.

I think the earliest thing that would be the highest yield would be that hospitals look at restarting elective surgeries. That would be priority one. This would be the highest on the triage list of what is getting back to normal. And then gradually we would probably have more leeway in public settings. But I think we also have to be mindful that this comes with a large degree of surveillance and a large degree of testing, a large degree of capacity. If there are a large number of cases in a particular area, we need to know about it and people need to have access to diagnostic testing and isolation if they are positive. And it's not just a linear pathway forward. There may be steps backward if there is evidence of an outbreak or a greater number of cases in a certain situation.

So I don't think people should just say, 'Ok, we've done the hard part and now we can just gradually open up.' This might not be a linear path forward.