Seven months in, the Canadian province of British Columbia and the American state of Washington offer starkly different portraits of pandemic life.
After confirming some of North America’s earliest cases in late January, Washington and British Columbia became the early epicenters in North America, serving as bellwethers on both sides of the border. The containment and mitigation efforts employed in these two communities—which share a good number of geographic and cultural similarities—offered glimpses into potential futures of how the virus might play out nationally.
At a glance, the current numbers look troubling for British Columbia. Daily confirmed cases have exploded since their low point in June and July, and now BC is rounding out August with case counts showing a 500% increase over the past month, exceeding the province’s first-wave peak in late March.
Just across the southern border, Washington seems to be heading in the other direction. From its peak of confirmed cases on July 6, the state has shown a clear downward trajectory over the past month, cutting its daily case count by more than half.
But the data can be deceiving. The ebbs and flows of new cases are largely timed to the respective governments’ schedules of closing and reopening their economies—a complicated process of starts and stops defined by what percentage of normal human contact an area is ready to embrace. The sudden ballooning of BC’s rate is timed to its increase to 70% of normal contact. Washington suffered a similar surge when it began reopening on May 26, tripling its daily case count within six weeks, forcing the governor to pause all future reopenings indefinitely.
More telling are the actual numbers we’re dealing with. From confirmed cases in the single digits in June and July, BC is now ticking past 100 per day. These are BC’s largest single-day counts since the pandemic began, but still lower than Washington’s current ”low” counts of 300-500 per day, down from its peak of more than 1,000 new cases on July 6. Although Washington’s population exceeds British Columbia’s by approximately 52%, its peak case count was nearly 10 times that of BC, and its total count — 74,320 cases and 1,905 deaths — dwarfs BC’s total of 5,496 cases and 204 deaths.
Why the sizable difference? And what do these radically different trajectories tell us about the local and national responses in each place?
To understand where we are now—and where we’re heading—we have to look at how each region’s response played out locally, and how those responses were impacted by federal intervention.
“Be kind, be calm, be safe.”
For the people of British Columbia, it has become a daily mantra. The phrase, “Be kind, be calm, be safe,” has appeared on everything from murals and bumper stickers to tea towels and painted rocks lining the Pacific shore. But for Dr. Bonnie Henry, BC’s provincial health officer, it’s a carefully calculated communications strategy, giving the public a message they can embrace.
A few hours south in Seattle, health department messaging has a markedly different tone. Dr. Jeff Duchin, the senior public health official for Seattle and King County, provides simple and staid advice: “More hand-washing, less face-touching.” While not as catchy as Dr. Henry’s—you won’t find it inscribed on a limited-edition Fluevog shoe—it has been a clear call to action in otherwise confusing and unpredictable times.
The early outbreaks on the West Coast have cast both Henry and Duchin in a very bright, unfamiliar spotlight. Duchin and Washington State health officer Dr. Kathy Lofy have conducted national briefings alongside the U.S. Centers for Disease Control and Prevention (CDC), and Henry, who publicly shed tears for the dead and gave daily podium updates with a home-spun haircut, has become a recognizable folk hero, appearing in interviews across Canada, in the New York Times, and on CNN. As health officials, they were largely unknown before the pandemic. But as local communicators on the national stage, they became recognizable figures in the first few months of the crisis.
Early action saved lives
Relative to their fellow states and provinces, both Washington and British Columbia handled their responses effectively, largely due to early action by elected officials who heavily relied on the advice of health authorities.
Seattle Mayor Jenny Durkan issued a state of emergency on March 3, when there were only 27 cases in the entire state. A week later, Washington Governor Jay Inslee banned all gatherings of 250 people or more, and began closing schools, libraries, and community centres. Over a series of increasingly aggressive measures—closing bars and restaurants, halting evictions, and finally issuing stay-at-home orders—Washington significantly slowed the spread of the virus.
By early April, the containment and mitigation strategies were working well enough for Washington to donate most of its federal allotment of ventilators to other states. On April 29—100 days after its first case was confirmed—Washington tallied 14,100 cases and 801 deaths, numbers that comparable states would come to dwarf in a week. (Arizona, with a slightly smaller population, recorded nearly 4,800 new cases in a single day.)
British Columbia did even better. With a population of roughly 5 million (compared to Washington’s 7.6 million), BC marked its 100th day with 2,255 total cases and 124 total deaths. With one of the lowest death rates in all of North America and Europe, the province has received international acclaim for its early response, largely due to its robust public health system and clear lines of communication among health department divisions. BC coordinated and scaled up its pandemic response with impressive speed, even developing one of the first diagnostic tests in the world, before Canada even recorded its first case.
BC had several advantages, including the luck of timing. A week behind the outbreak in Washington, British Columbia knew the close proximity and porous border would make Vancouver the next likely hotspot, and they did everything they could to get ahead of the game. With the benefit of hindsight, they took early measures to contain the spread—including launching a well-funded contact-tracing program, issuing travel advisories during spring break, and focusing on basic public health protocols like physical distancing and handwashing—a subject Henry promoted in her 2009 book, Soap and Water & Common Sense.
Another advantage for BC was the large Chinese and Iranian communities in the southern part of the province. With China and Iran among the earliest and hardest-hit nations, these enclaves were wearing facemasks, promoting social distancing, and canceling large events weeks before the BC government began advising these measures. And it worked—several months into the pandemic, they were recording some of the lowest transmission rates in the province.
Both BC and Washington are considered success stories in flattening the curve early. The local governments let their scientists control the conversation, only taking the mic to reinforce the messaging, and then supporting that messaging with decisive action. After an outbreak at a suburban plant nursery, BC began quarantining thousands of temporary foreign workers as they arrived in Canada, intercepting dozens of positive cases that could have otherwise spread across the province. Washington purchased an EconoLodge to isolate homeless people who had tested positive. Both places—after learning the painful lesson of the susceptibility of nursing homes—restricted direct contact with the elderly.
By acting early, listening to health professionals, and engaging the public to cooperate for the greater good, the first three months of Washington’s and BC’s responses offered models for how the rest of the U.S. and Canada could respond effectively to the virus and save lives.
One crisis, two systems
But the similarities ended once the federal governments became involved.
For the most part, Canadian provincial leaders have valued the federal response. Even figures normally critical of the ruling Liberal party, like Ontario Premier Doug Ford, offered praise for the administration’s handling of the crisis, and though off to a slower start, emulated BC’s cooperative strategy. Like in British Columbia, federal leaders have largely let their health professionals lead on the communications front, and like Bonnie Henry, Canada’s public health officer Theresa Tham has become a household name.
That’s not to say there hasn’t been some division and opportunism. Four months after Canada’s first case, Alberta Premier Jason Kenney continued to downplay the coronavirus as an “influenza,” and doubled down on his promise to gut financial support to the medical sector, stoking fears of a mass exodus of healthcare professionals from Alberta at a time they’re needed most.
But largely, with varying degrees of success, Canada has avoided framing the pandemic as a battle of ideologies. British Columbia’s approach set a cooperative tone nationally, and despite the occasional misstep and some pushback from business interests, Canada has managed to emerge seven months on with about 3.3 cases per 1,000 people.
The United States is marking the same anniversary with about 16.4 cases per 1000 people, a rate that is rapidly growing. The administration’s public feuds with its own health agencies and the state governors—notably Washington’s Inslee—have dominated the media landscape and clouded the messaging. Americans may be doing more hand-washing and less face-touching, but at the federal level, being kind, calm, and safe seems more of a Canadian thing.
From an early point, the White House’s regular assaults on the data—and often on science itself—have threatened success on every front of the battle. Instead of taking preemptive action, the president ignored warnings for months, claiming the virus would disappear “like a miracle” while it was gaining footholds across the country. Instead of health professionals leading the U.S. response, the nation’s Coronavirus Task Force was headed up by Vice President Michael Pence, a man who doesn’t believe in evolution, climate change, or the lethality of cigarettes, and who as Indiana governor stated that prayer would guide his decisions during an HIV epidemic. Instead of engaging the cooperation of the people, the president’s allies actively pushed the narrative that a stable economy was worth sacrificing the elderly—and in the interest of maintaining their future earning potential, an acceptable number of children too.
The CDC has largely been sidelined at a time when they are most relevant. “I’ve never seen so many people so frustrated and upset and sad,” a former senior CDC official told the New Yorker magazine in April. “We could have saved so many more lives. We have the best public-health agency in the world, and we know how to persuade people to do what they need to do. Instead, we’re ignoring everything we’ve learned over the last century.”
Naturally the disconnect between federal action and local needs has been a recipe for disaster, one whose true costs have only begun to show. Washington authorities have been particularly vocal about problems they were having with the federal response, including delayed or missing shipments, supplies that didn’t meet minimum health requirements, and being forced to close a promising CDC-approved testing program.
Not a new normal
The chaos in the United States is not solely the result of a rudderless country. The impact of its disorganized national response is magnified by the abysmal and byzantine healthcare system built on keeping people sick and addicted to treatment. Despite the proven value of public health programs—worker safety laws, vaccines, investments in sanitation, clean water rules—as the most effective and efficient means of keeping a healthy populace, the U.S. runs on a profit-driven healthcare system, where being healthy isn’t good for business.
Across America, health departments have shrunk almost 30 percent in the past 12 years, and per capita medical costs have grown to twice the average of developed countries. Often, going to the hospital isn’t a health choice, it’s a financial decision. Even the simplest of procedures that could prevent far more complicated issues—such as testing for hypertension, which exacerbates COVID-19 symptoms—are inaccessible or unaffordable to a large percentage of the population.
With a healthcare system that barely operates under its average load, the pandemic has laid bare how truly vulnerable Americans are in an actual crisis, and how broadly dysfunctional the system is. Coronavirus testing kits can range between $20 and $850 depending on where you live and what kind of healthcare plan you have. And that only covers the cost of the kit, not the cost of the hospital visit, which can easily total in the thousands. After West Seattle resident Michael Flor spent 62 days in the hospital recovering from COVID-19, he told the Seattle Times he nearly died again when he saw his bill: 3,000 itemized charges, across 181 pages, totalling $1,122,501.04.
In Canada, universal healthcare is a point of national pride. There are issues, as in any large system—constant battles between health-worker unions and provincial bean-counters, long lines for non-emergency procedures, and patient waitlists for scarce specialists. But all in all, the country’s healthcare system is internationally respected, and has held up remarkably well under an unprecedented assault on its resources.
The pandemic has, however, revealed cracks in Canada’s political and societal facade that have cost thousands of lives.
Ineffective provincial-level leadership that downplayed early warnings and re-opened businesses prematurely have resulted in outsized infection rates in Quebec, Alberta, and Ontario, which combine for more than 93% of cases across Canada.
Inadequate staff, supplies, and oversight at Canadian nursing homes and long-term care facilities have led to a rash of devastating outbreaks that account for more than 80% of COVID-19 deaths in the country. The hodgepodge of public, non-profit, and commercial entities aren’t covered by the Canada Health Act, the backbone of the universal healthcare system. With aging infrastructures, ill-treated workers, and poor sanitation practices, the lack of coverage and oversight at these facilities resembles the U.S. system of finance-first healthcare, and has been described by numerous critics as “Canada’s national shame.”
The battle to come
Today, both BC and Washington are struggling with a new front in the war: school reopenings. And again, they are headed on similar paths, both mandating that schools provide in-person instruction this fall.
In both locales, there is pushback. The Seattle School Board—the state’s largest—voted unanimously to start the new school year with remote classes only. In British Columbia, despite endorsements by Premier John Horgan, Health Minister Adrian Dix, and Dr. Bonnie Henry, the return to classrooms has not been well-received by parents and educators who worry that seven months of sheltering will be squandered in the first week.
But Horgan, Dix, and Henry are convinced that the strategy that gave them early wins in the spring are not going to work as well in a return-to-school plan. While first-wave precautions focused on cleanliness, social distancing, and isolating the elderly, second-wave actions will step up enforcement. The province has started going hard after people holding large parties, the main source of the current spate of infections. And recognizing the impossibility of social distancing in school groups, health leaders are focusing on keeping students in bubbles to limit the spread of any new community transmissions. The province has also hired 500 new contact tracers to reinforce the lynchpin of its outbreak-response strategy, hoping to keep the inevitable new infections below a threshold that will allow schools to stay in session.
Whether Canada or the United States will learn the lessons the pandemic offers is anyone’s guess, but the gaps have been exposed and the direction forward made clear. On both sides of the border, better elder-care, investment in public health initiatives, and free diagnostic programs not only keep a healthier populace in good times, but allow the system to bear more stress during the bad, and keep it from completely collapsing during the worst. While not an immediate solution for the current crisis, these long-term investments would likely gird the U.S. and Canada for the pandemics yet to come.
Maintaining the message
There is an old military adage that the most valuable weapon on the battlefield is a radio. In the fight against the current pandemic, the most valuable weapon is an effective communications strategy: between administrative departments, between federal and local officials, and between the government and the governed.
Community involvement will be crucial to containing future COVID-19 numbers. So as simple as a sound bite might seem, it forms the nexus of the relationship between the health authorities and the community at large. But as isolation conditions drag on and old messages get stale, the public’s stamina for altruism will slowly crumble, leading to moments of carelessness that launch new outbreaks in places that did everything else right—and then it’s back to square one.
Neither the people of BC or Washington can be expected to maintain their cautious stance indefinitely. Infections are less about how much you’re being careful and more about the moments you relax your guard. New outbreaks could appear anywhere, at any time. The greatest challenge going forward will be creating a sustained messaging campaign that the public can engage without exhausting itself with “lockdown fatigue.” And it is here that the magic behind Henry’s sound bite reveals itself. It is a message for the long haul, a message that, instead of telling people what to do, tells them to remember their best nature when they do it: to be kind, to be calm, and to be safe.
Graphics by Jonathan Ventura, additional research by Stephane Lavoie and production support by Oscar Beardmore-Gray.
This story has been modified and updated since its original publication.
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