COVID-19: Dr. Jennifer Kwan on how to manage and reduce your own risk

On the latest episode of the NOW What podcast, family physician Jennifer Kwan offers strategies for the second wave

Ontario’s COVID cases are rising sharply, with Toronto accounting for roughly half of each day’s new numbers. That’s left both the province and the city scrambling to reformulate the testing strategy to clear the backlog and move forward more efficiently.

On the latest episode of the NOW What podcast, Dr. Jennifer Kwan, a Burlington family physician who’s been providing COVID-19 data visualizations on Twitter throughout the pandemic, discusses where things stand, where they might be going, and what we ought to be doing to blunt this second wave.

“It’s been an interesting week for sure,” Kwan says. “Every day there are more and more cases in Ontario and that’s something to be concerned about, along with the rise in customization and ICU numbers and that testing backlog number continues to increase.

“[On October 5], it has improved a little bit, which is good, but it did get to over 90,000 [pending cases] at one point,” she adds. “Now they are limiting testing, so it is a little bit concerning that we may not have a very accurate sense of what is actually going on right now.”

Why not test asymptomatic people?

Kwan puts the province’s decision to stop offering COVID-19 tests to people who aren’t already exhibiting symptoms into context. (At least 45 per cent of cases present asymptomatically, meaning those people might not even suspect they have the virus – while remaining just as infectious as someone with symptoms.)

“If we had unlimited tests and adequate testing capacity and processing capacity, we wouldn’t have to be getting into triaging the most high-value [people to be] tested,” she explained. “Unfortunately, because of the limit and the backlog, they’ve had to figure out what is the highest yield for testing.

“Asymptomatic testing does have some value: for example, [White House press secretary] Kayleigh McEnany. She was asymptomatic and she got tested and she’s positive and now she’s quarantining – and that prevents her from infecting other people. However, if you don’t have enough tests then you may [have to] target the test to people who may be at higher risk and may be symptomatic – and then you have a higher likelihood the test will actually be positive.”

Ontario’s testing supply

In any conversation about Ontario’s pandemic strategy, there are always larger questions looming: we’re seven months into this. Shouldn’t we have an adequate supply of tests and a comprehensive strategy for administering them by now? Why hasn’t the government been able to figure this out, or at least present a consistent messaging strategy?

Similar questions were asked around Ontario’s school reopenings last month, as well.

“I can sense the anxiety around schools, especially with increasing cases and outbreaks and the constantly changing testing criteria,” Kwan says. “What we need is clear communication and not something that changes all the time, every day. It even confuses us physicians because we get requests from parents saying, ‘Okay, my child has a runny nose – can they go to school or do they need a test?’ The answer yesterday might change compared to today.

“We are getting pages and pages of updated public health guidance every few days and even we are confused – so if we’re confused, I’m sure parents are equally, if not more, confused,” she continues. “If, for example, they are limiting the testing criteria, that [needs to be] accompanied with an explanation of why. Is it because there’s not enough tests? Is it because these people are considered lower risks? Just more explicit communication to justify these actions. And that would also help physicians explain to our patients and the public why we have to follow these recommendations.”

Public health messaging around Thanksgiving

With the provincial government reluctant to consider another lockdown while Toronto’s medical health officer recommends virtual Thanksgiving celebrations as the safest option for people living alone, it doesn’t seem like the messaging at different levels of government will cohere any time soon.

“We have to look at ways to manage and reduce our own risk,” Kwan says. “Even if something is allowed, it doesn’t mean it is safe to do [that]. We know based on the characteristics of the virus, that higher risk activities would be indoor and closed spaces with crowds,” she says. “For example, indoor dining: most people aren’t wearing masks when they’re eating and also in-between eating. People may be talking and not wearing a mask, so that can increase their risk.”

What about closing down restaurants?

“I understand it’s a very difficult time for business owners, and I don’t think it’s fair to compare a small restaurant that may not have any distancing or stricter safety protocols versus maybe a restaurant with a larger distancing; maybe they’re screening people more effectively.

“[But] if public health has the information and if some sort of subset of activity is proven to lead to outbreaks and cases, then they should be either addressing what is causing is it – is it having to reduce capacity, or do those spaces need to be temporarily shut down? It’s definitely not an easy question,” she says. “But again, we need more transparency, transparency from officials to explain why some things are closing and some things are not, right?”

Listen to the whole conversation with Dr. Jennifer Kwan on Apple Podcasts or Spotify, or just play it below.

NOW What is a twice-weekly podcast that explores the ways Torontonians are coping with life in the time of coronavirus. New episodes are released every Tuesday and Friday. And remember, we’re all in this together.


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