Enforcement versus endurance in B.C.'s pandemic response
VANCOUVER -- As the health minister warned that new enforcement measures are on the way this week, a Harvard epidemiology professor is weighing in on B.C.'s approach and warning heavy-handed enforcement could force private parties and other possible "super-spreader" events underground.
On Monday, Adrian Dix said private indoor parties were the biggest driver of record-high infection levels in the province and that the solicitor general would be making announcement in the coming days about how and when rule-breakers would be dealt with.
"We cannot let a few wreck it for everyone else and that is why action is being taken," said Dix.
Assistant professor of epidemiology for Harvard University, Julia Marcus, praised provincial health officer Dr. Bonnie Henry’s education over enforcement approach thus far – calling her an exemplary public health leader in her positive messaging. But she also agreed there’s a time and place for enforcement.
"I think that actually it can make sense in some situations but it should be used as a last resort in the context of public health specifically," said Marcus. "And I think also if it's going to be used, it needs to be used very judiciously and really with an eye toward what is the goal here? Is this going to deter this behaviour or is it just going to drive it further underground? Is it going to drive people away from public health efforts?"
She also emphasized that not only must messaging to young people in particular be empathetic to their loss of social connections, but it must also take into account the situation we all find ourselves in where the sacrifices in our personal lives are indefinite.
"If this (pandemic) had been something that would be over in just a few weeks, we could have really tolerated quite a lot of isolation, and now that it's turning into something that could go on for a year or more, we really need to be thinking not just about minimizing infection but also making sure people's well-being is sustained and they have the endurance to keep their risk low," explained Marcus.
Various jurisdictions have taken different approaches to those flaunting public health orders and gathering in large groups or close quarters, not to mention those refusing to wear masks in designated areas. In June, the Canadian Civil Liberties Association reported that Quebec alone had levelled $10 million in COVID-related fines, while the mayor of Los Angeles has authorized utilities to cut services to homes and businesses hosting large parties. In Australia, police are preparing to use drones to nab rule-breakers.
But there’s little evidence that hardline enforcement equals compliance when it comes to safe practices that curb infection. In fact, Dr. Reka Gustafson, B.C.’s deputy provincial health officer, says overall people have done a good job and said there’s been only one infection reported from outdoor contact.
"The vast amount of transmissions are occurring in close, prolonged contact, especially in indoor settings among people who are spending a lot of time together and in very close proximity," she said.
Marcus and other public health experts believe giving people safer options is better than expecting them to stay home all the time, particularly when so many young people may be living in cramped quarters.
"We do have a lot of information now about where transmission risk is highest and where it's lower and if we don't encourage people to engage in these lower-risk activities, they're going to end up having indoor house parties and engaging in activities that really can become super-spreader events and that's what we really want to avoid," she said, pointing to patios and socializing in parks as better alternatives.
"Is it zero risk? No, it's not zero risk. Is it less risk than crowded indoor parties? Absolutely."