The COVID-19 Endgame: How the Credibility of Public Health Could be Won or Lost

Public health officials all over the world have been featured prominently alongside political leaders as recommended control measures have been put in place to help slow the COVID-19 pandemic. To save lives and minimize disease transmission, physical distancing and social isolation are having a tremendously deleterious effect on economies, as well as people’s social and mental health. The trust being placed in our public health institutions could be jeopardized if the endgame of this outbreak is not effectively directed and managed.
 
The endgame I am referring to is the timing and logistics of the elimination of existing social, travel and economic restrictions. Restoring ‘normal’ practices will require balancing a fine line between the need to return to social and economic stability while minimizing disease transmission and the resulting strain on the health care system. Once case numbers of COVID-19 start to fall, there will undoubtedly be pressure from the public to reopen facilities and remove restrictions on travel. To ensure the optimum health of the public, it is imperative that these decisions are not made solely by political leaders but are made under the advice of public health professionals.  

There are two critical components that public health professionals need for effectively managing this endgame, and preparations need to be made now if necessary information is to be available when needed. The first is that public health needs to have access to rapid and accurate detection of every single person that is actively shedding the virus. This activity is what the World Health Organization has been recommending from the start of the outbreak,¹ and for which many countries, including Canada, have not been properly prepared. Movement restrictions cannot be relaxed for people actively shedding virus, as they could be responsible for initiating a second wave of infection. Failing to identify contagious individuals is a recipe for disaster and may result in the call for reinstating or prolonging lifestyle restrictions, which will likely be extremely unpalatable to the public.

The second factor is the ability to accurately categorize individuals as either protected, actively infected, or vulnerable. Until a vaccination is available to establish immunity in populations, which is likely to take twelve to eighteen months, immunity will have to be acquired through natural exposure to the SARS-CoV-2 (COVID-19) virus. If a person develops enough antibodies to this virus, the hope is that they should, at least temporarily, be protected from being infected a second time and further should not be able to transmit the disease to others.2 Once protective immunity levels have been established, using serological testing to identify protected individuals is critical to risk management and stopping disease transmission.² These protected individuals should be the first wave of people allowed to start establishing return to normal function of our society, and it is logical to assume that could happen once protective immunity levels have been determined.   
 
Up until this point in the pandemic, public health professionals in Canada have served to provide evidence-based advice that has been used to develop public policy and they have often been the face of delivering messaging to the public. As our society moves into the next phase of COVID-19 management, being able to track people shedding virus and distinguishing those with protective antibodies will allow public health officials to continue to act in decisive and responsive ways to steer government policy and public behaviours.

Protecting the health, freedom and economy of our population is critical during this pandemic, and management of the pandemic recovery may mean the difference between establishing long-standing credibility for public health in Canada or eroding the public’s trust in it entirely.
 
References

1. World Health Organization.  (2020).  Coronavirus disease (COVID-19) technical guidance: Surveillance and case definitions. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/surveillance-and-case-definitions.
2. Altmann, D.M., Douek, D.C., Boyton, R.J. (2020) What policy makers need to know about COVID-19 protective immunity. The Lancet, 395 (10236), 1527-1529.  https://doi.org/10.1016/S0140-6736(20)30985-5.