Covid-19 is a strange disease. It can be so mild that people do not notice that they have it, or it can be fatal. People are infectious for about two days before they get symptoms, so it can be spread by people who feel they are well and who would pass any screening, including temperature checks. There is no vaccine and little in the way of effective treatment. Fortunately, about 80% of cases only need simple supportive care, with pain killers, cough medicine, adequate liquids to drink, and a cold cloth to help with the fever. The roughly 5% of people who get very sick, often about ten days into the illness, are usually admitted to hospital, but the success rate of invasive procedures like intubation and ventilation are disappointing. Dexamethasone helps some people survive severe disease, and some antivirals show promise, but there are no really effective treatments and no vaccine likely to appear in 2020.

Canada has done reasonably well in managing Covid. We have a coordinated response from politicians at all levels of government and from all political parties. We have respected Public Health officials giving clear and direct messages. Canadians are in general pretty polite, considerate and law-abiding people who trust their government, so they have largely cooperated with Public Health and obeyed restrictions. As a result, Canada has flattened the curve and Covid-19 cases are now in a steep decline across Canada. Despite issues with an initial shortage of PPE and limited availability of testing, we have done much better than some countries. This graph shows the seven-day moving average of new Covid-19 cases on a per 100,000 people basis in Canada and four other countries:

Canada (black) flattened the curve after about 30 days and new cases have declined steadily from 60 days to date. Sweden (orange), which had much lighter and often voluntary restrictions, had a similar trajectory to Canada until about 90 days, and now has over twice as many cases as Canada ever had. The United Kingdom (purple) briefly attempted to achieve “herd immunity” and was slow to get testing organized. It has had a similar trajectory to Canada but with over 50% more cases per 100,000 population. The USA, with no effective national political leadership, a distrust of government, and a politicized approach to the pandemic, had about twice as many cases as Canada between days 40 – 75. After that, cases declined in Canada but started to rise again in the USA, as some states re-opened prematurely and without adequate testing. In Brazil, the President has chosen to downplay the significance of Covid and cases are skyrocketing.

The cumulative total death rates show similar results, with the United Kingdom (red), Sweden (orange) and the United States (green) all showing much higher death rates per 100/000 population than Canada. Brazil is also now has a higher death rate than Canada, after a slower start.

Many Asian countries have done much better than Canada:

China, Taiwan, South Korea and Vietnam all managed to flatten the curve and get over the peak much more rapidly than Canada, with many fewer cases per 100,000 of the national population. The comparisons of cumulative total death rates per 100,000 make an even greater contrast. The proportion of the total population who died is negligible in these four eastern countries.

Many Asian people are used to wearing a mask in public, which probably helped. Also, many of these countries have strong governmental controls over personal liberty. Public Health officials were allowed to access cell phone data and other personal information. In China, the use of an app was required to travel on public transport. In Western countries, this level of government “snooping” into personal lives would not be acceptable, as demonstrated by the controversy around contact tracing apps in many Western countries.

Which Western countries have done better than Canada?

There are a handful of Western countries that have done significantly better than Canada. Australia ((orange) has the obvious advantage of being a remote island nation that can easily close its borders. Slovenia(green) mandated the wearing of a mask in public. Population size, density and age probably played a role. Canada may have had more international travellers than other countries.

As Canadians, we can feel proud and lucky that we have avoided the worst mistakes made by some other countries, and contemplate what we could learn from imitating some of the global superstars in managing Covid-19. Before we get too complacent, we should study one last graph:

This graph contrasts what has happened in Canada (black) with the outbreaks in Iran ( orange), and the global situation ( pink).
Iran began with a similar trajectory to Canada for the first 40 days, then was much better than Canada at limiting new cases from days 40 – 70, but it then relaxed its guard and suffered a “second wave”, with the number of new cases at day 105 matching the previous peak around day 35.

Finally, the global outlook (pink) is very disturbing. The number of new cases is rising slowly but steadily with no sign of slowing down. On June 21st the WHO noted that a new record high of 193,020 new cases of Covid-19 globally. Some people are still travelling internationally, and in Europe borders between countries are reopening. This may be dangerous. For example, New Zealand was able to entirely eliminate Covid-19 from the whole country but then got several new cases from international travellers.

As long as Covid-19 exists in the general population in even a single country, no one is safe. Even in countries that have been badly hit by Covid, the vast majority of the population was never infected and remains vulnerable. There are no guarantees that infection results in long-lasting immunity. We should enjoy the summer sunshine while we can and take advantage of the cautious re-opening of businesses, but we must remember that constant vigilance is the price of liberty, at least until we have an effective treatment or vaccine.

Data source:
The graphs were created using an interactive modelling tool made available by CTV on their web site.
“COVID-19 curves: Compare Canada and other key nations” by Jesse Tahirali (@jessetahirali) CTVNews.ca Digital Content Editor. Last Updated Saturday, June 20, 2020 11:48AM EDT
https://www.ctvnews.ca/health/coronavirus/covid-19-curves-compare-canada-and-other-key-nations-1.4881500