Covid-19 mitigation strategies and considerations

Canada and the world are at a critical stage with the Covid-19 pandemic. As the situation evolves, there is a need for a clear set of considerations and principles to inform decision-making. The mitigation strategies and considerations presented in this commentary aim to inform discussions around a balance between controlling the virus (and its negative health consequences) and reducing the economic implications of the pandemic.

As governments are planning for the gradual return to usual activities, approaches should be based on a clear set of goals and objectives. Control, or mitigation, of the effects of Covid-19 is the presently achievable goal (vs. eradication or elimination) given that Covid-19 is likely to become an endemic disease – one which continues to circulate indefinitely. As per lessons from previous pandemic situations, government decision-making should be guided by principles that include collaboration, evidence-informed decision-making, proportionality, and flexibility, to minimize serious illness and overall deaths, and to minimize societal disruption resulting from the pandemic. Furthermore, attention to frameworks for ethical decision-making and equity considerations are critical in planning and implementation of interventions.

Canada has now greatly accelerated its pace of vaccination, although risks remain with respect to supply chains, uptake and emerging variants of concern. While achieving high levels of vaccine coverage is essential, the focus for those leading the pandemic response strategy must remain on the control of transmission of disease and on decision-making about reopening that is based on disease transmission metrics, rather than arbitrary levels of vaccination or fixed dates.

Canada is making progress with its immunization program, but the variants have contributed to a large third wave in many parts of the country. Measured approaches are necessary to control this wave and to avert future waves. It is important to find ways to maintain public confidence to ensure support for the necessary public health measures to control the spread of disease, maximize confidence in the vaccines, and achieve maximal uptake. Clear, consistent, coordinated, and timely communications are critical in achieving these aims.

To conclude, as national governments are planning a path forward, clear and timely guidance is required not only for the provinces and territories, but also to provide Canadians with ‘hope’ that we will gradually return to some level of normalcy. There are several areas for which clear national guidance could be of value:

1. A risk-based framework to guide reopening of services based on local epidemiology and vaccine coverage. The framework should focus on disease transmission, and public health and health system capacity indicators to guide reopening rather than simply measures of vaccination coverage or fixed dates.

2. Recommendations on the appropriate use of documentation, i.e. certification of vaccination, and whether proof of vaccination should be mandatory in some settings.

3. A border strategy that combines testing and quarantine of appropriate duration based on risk to ensure protection from the importation of virus variants while still facilitating travel.

4. Assessment of key learnings from behavioural science disciplines to support messaging and communications to ensure public acceptance of public health measures when necessary and when vaccines are offered.