How Should Saskatchewan Reopen the Economy amid the Pandemic (瘟疫流行期萨省经济应如何重新开放)?

Abstract: The Saskatchewan government's five-phase plan to reopen the province gradually is set to begin on May 4 to keep the economy going while physical distancing and personal protection protocols are followed, and large public gatherings are still prohibited and schools closed for an indefinite period. The reopening guidelines set by the Federal Government require that the numbers of new COVID-19 cases and hospitalizations have stabilized and that the rate of new cases are “maintained at a level that health care systems can manage,” and the provincial public health systems still have the capacity to “test, trace and isolate all cases” with support available to implement workplace protocols and put measures in place “to prevent the controlled spread of the virus in vulnerable populations”. In SK, the daily increase of cases is still sometimes larger than 15. Then, there is also the issue of imported cases from the US and other severe provinces. Next, there may be the issue how we can be sure that we have adequate health care capacity and that we can monitor and sustain the cases successfully in addition to a back-up plan. As to the reopening, the kind of businesses relaxed need to have the least impact in triggering back the virus and the best economic result for the economy. Also, a strategy for an internally loose yet externally strict province needs to be carried out, and the time table needs to depend largely on the easing situation of the cases, especially the community transmitted ones. The areas to be opened first can be rural areas, small towns where no cases are suspected and it is hard to spread the disease. The Saskatchewan economy needs to be reopened, but it takes both strategy and skill to make it happen.

Key Words: COVID-19, reopening, imported cases, monitoring, back-up plan

I. The Plan to Reopen the Economy

With the pandemic hanging on, Saskatchewan’s slowed economy will fare even harder (please see below the table for economic stattistics comparision). The Saskatchewan government's five-phase plan[i] to reopen the province is set to begin on May 4. Moe said, "if we move too slowly, we risk permanent damage to the livelihoods of thousands of Saskatchewan people. Businesses that never reopen, and jobs that never come back." "Over the next several weeks, restrictions will be gradually lifted by adding more types of businesses to the allowable businesses list, meaning that they can reopen if they so choose," Moe said in a news release. "All businesses and public venues will be required to continue following physical distancing and cleaning and disinfection practices to protect both employees and customers. Members of the public will be expected to follow physical distancing rules and to stay home if they are experiencing any COVID-19 symptoms." The focus was to ensure Saskatchewan residents are kept safe and that businesses affected by the pandemic can stay afloat, and it was not the goal to have Saskatchewan be the first province to reopen. 

Phase 1, set to begin May 4, will see restrictions lifted on certain medical services with boating and fishing. Golf courses can open on May 15, and rentals of golf clubs and pull carts will be allowed with strict guidelines and cleaning procedures like cleaning and disinfection to be followed. Phase 2, set to begin May 19, will include the opening of retail businesses, pro shops and personal services not initially allowed under Saskatchewan's state of emergency. Returns and exchanges are allowed with the condition that any merchandise should be cleaned and disinfected before it is returned to the retail floors and should be isolated in a separate bin for 72 hours. Change rooms can be used with the condition of cleaning and disinfection after every use and that the capacity should not surpass 50%. Hair dressers and barbers can wash, cut, style and colour hair under phase two of the plan, but customers are discouraged to come earlier that 5 minutes in advance. Garden centres can be opened the same way as retail stores[ii]. Phase 3, to be enacted at a date still to be determined, will see the reopening of the remaining personal services except for hairdressers, registered massage therapists, acupuncturists and acupressurists, restaurants, gyms, child-care centres and the restrictions on public gatherings relaxed to 15 people. Phrase 4 will see openings of casinos, swimming pools, movie theatres, museums (please note that with New Brunswick’s plan there won't be any concerts or festivals in New Brunswick for at least the rest of the year, and bars and organized sports may not be able to start up again until a vaccine is available, which could take 12 to 18 months[iii]) and parks and public gatherings will be limited to 30 people. Phrase 5 will include the lifting of long-term restrictions.

Long-term restrictions on high-risk areas will initially remain in place through the first phases of reopening, including maintaining the current state of emergency and recommendations against non-essential international and inter-provincial travel. Mandatory self-isolation, with the threat of fines, will also remain in place. People have to self-isolate for 14 days if they have travelled internationally, have tested positive for COVID-19 or if they have come into contact with someone who has the illness. Visitation restrictions are still in place for long-term care facilities, hospitals, personal care homes and group homes. Large public gatherings are still prohibited.

Classes will remain suspended throughout the province's public and private schools, and restrictions will likely remain in place until further notice as Saskatchewan will be watching other jurisdictions closely.

The release of the reopening guidelines[iv] from the Federal Government comes after Ontario, Quebec, Saskatchewan, New Brunswick and PEI have already kick-started or announced their staged plans for loosening public health restrictions and restarting economic activity. “A shared key objective is to minimize the risk of another wave of COVID-19 that forces governments to re-impose severe restrictions, further damaging the social and economic fabric of communities,” said a statement released by the Prime Minister’s Office on Tuesday. To that end, the statement outlined seven criteria (regarding information, medical supplies, support system and crisis management) and measures that the provinces have agreed are “needed” before public health restrictions are loosened during this first wave of the pandemic. Chief among them is that transmission of the virus is “controlled.” That means, according to the document, the numbers of new COVID-19 cases and hospitalizations have stabilized and that the rate of new cases are “maintained at a level that health care systems can manage.” On top of that, the provincial public health systems should have the capacity to “test, trace and isolate all cases” and governments should support the implementation of workplace protocols and put measures in place “to prevent the controlled spread of the virus in vulnerable populations” — including seniors, inmates, the homeless population, Indigenous peoples and essential workers. The statement noted that decisions to re-open the economy will be based on the principle of “science and evidence-based decision-making.” It is urged that strong measures must be in place for this new normal phase of living with COVID-19 to contain future waves or outbreaks.

Alberta on April 30 detailed its plan to gradually reopen the economy and allow for more social and recreational activities, including resuming access to parks and public lands will also be restored starting from June 1, allowing vehicle access to parking lots and staging areas, as well as boat launches. Golf courses can open starting from June 2 (if they keep clubhouses and pro shops closed), as well as some scheduled, non-urgent surgeries, dental, physiotherapy, language pathologist and dietitian services starting from May 4. Starting from May 14, dine-in restaurants, cafes and daycares will be reopened with some restrictions such as 50% capacity for restaurants, making Alberta seemingly the first to reopen partially the economy though ON, QC and SK voiced out their plans first[v].

Manitoba is allowing restaurants to open patio services on May 4, along with retail stores and hair salons, while retail stores and hair salons will not be permitted in to open in Saskatchewan until May 19, and restaurants will not be permitted to open until Phase 3. Manitoba is also allowing museums, galleries, libraries, seasonal day camps and campgrounds to open on May 4 while Saskatchewan will not[vi].

II. Some Concerns Raised

On April 29, 2020, Saskatchewan had 17 new confirmed cases of COVID-19, bringing the provincial total to 383. Eleven of the new cases are from the far north (La Loche), five from the north region (four in Lloydminster) and one from the Saskatoon area. 13 cases in Lloydminster have been linked to a cluster based in Lloydminster Hospital, including five health care workers and eight patients, and transmission has occurred in the hospital setting. Also, a couple of mass-gathering events were recently held in Saskatchewan where organizers mistakenly believed that gatherings were allowed as long as attendees maintained two meters of separation[vii]. 

First, some industries need more specific guidelines. Specific information for banks and financial services, construction, small manufacturing, agricultural food processing, real estate, mining, etc., is not included. Secondly, if your summer is spent in playgrounds, summer camps, libraries, and outdoor swimming pools — more urban activities — the plan is disappointing. There is no similar guidance and those activities are disallowed until the to-be-determined time of Phase 4. Mayors, community associations and non-profit organizations, who would have good ideas on how to risk manage these activities, should be consulted. Thirdly, a popularly understood and robust testing and contact tracing regime will be good for consumer confidence. Fourthly, medical supplies and equipment should be addressed so that the reopened businesses know where to get them and what the protocols are. Some Saskatchewan business owners express they won't be opening next month when the government begins to lift the COVID-19 restrictions, saying it’s not the time yet and that it may be dangerous. For example, salons and hairdressers have no professional body to regulate them and there are only two provincial government inspectors for the entire province, while medical-grade personal protective equipment and masks, disinfectants and sanitizers are far from sufficient. This also applies to heath-related businesses[viii]. Fifthly, there should be precautions for a proportion of patients with no symptoms. Professor Christian Drosten mentioned children were infected with the new crown virus based on the data of the new crown virus in southern China collected earlier this year. While the proportion is not lower than that of adults, the incidence of children is low. In other words, children are asymptomatic and they will pass the virus to others[ix]. Sixthly, measures need to be taken regarding populations from outside Saskatchewan, especially from the US, Quebec, Ontario and BC. Actually, the cases in Singapore rose dramatically with imported cases. Seventhly, a Plan B should be set up in case Plan A fails.

NDP leader Ryan Meili said there are still questions about Saskatchewan's health care capacity should the province see an increase in cases, as well as questions about how officials will determine whether or not the phases were successful. NDP leader Meili said the plan also doesn't include any details about how the province will support Saskatchewan's most vulnerable, like senior citizens and those who are homeless. The NDP also questioned what Plan B the province would have if the phase-in doesn't go well, saying the plan needs to be focused on keeping Saskatchewan residents safe as opposed political optics. Consultation with municipal and community leaders is also said to be lacking. Meili said the government needs to get the plan right to avoid a situation where the province is forced to close again after reopening[x].

III. Lessons and Experiences to Be Learned

The management of the City of Wuhan once said, the release of the lockdown did not mean the release of precautions, and a zero-case situation did not mean a zero-risk one[xi]. At the beginning of March, Hubei Province (where Wuhan is) divided the risk levels of the epidemic areas, taking counties and urban areas as the unit, based on the number of cases diagnosed for 14 consecutive days and the clustered epidemic situation as the standard, and divided them into high, medium and low levels. High-risk areas outside Wuhan would resume those businesses important in people's daily lives, as well as those in financial, insurance, harbor, cargo transport industries, and key industrial chain facilities; medium-risk areas could resume locally based industrial and agricultural enterprises in industrial chains, as well as construction industry and industries in law, accounting and other services; low-risk areas could recover all the other businesses except for movie theaters, bookstores, Internet cafes, bars, beauty shops, training institutions, etc., which have a high concentration of people and closed venues. For regions with different risk levels, the degree of recovery of transportation and passenger traffic is also different. Mobile personnel need to use the electronic health code to pass, or take a charter vehicle "point-to-point". There was argument on how to assess the date to reopen after several days of a zero-case situation, how to maintain a consistent relaxation policy, and whether to bring in medical experts and front-line workers to the decision-making[xii].

As of April 7, South Korea had conducted more than 477,000 COVID-19 tests or one test for every 108 of its citizens. The country’s aggressive testing strategy, supported by a robust information campaign including multiple daily text messages to all South Koreans identifying COVID “hot spots,” has helped the country avoid the widespread economic disruption and school closures that characterize much of the Western world’s responses[xiii].

In Prato, a small city in central and northern Italy, there is a population of about 200,000. Official data alone show that there are nearly 30,000 Chinese. However, today, two months later, there are 513 confirmed cases of new coronary pneumonia in Prato. The local Chinese community has maintained zero infection from start to finish due to its self-discipline, self-help and self-organization. There are 9147 cases of infection in the Tuscany region where Prato is located, and 199414 cases in Italy[xiv].

In Singapore, according to United Morning Post, foreign labor cases have surged in the past few weeks, and now it has exceeded half of Singapore’s total number of cases, with 43 foreign workers’ dormitories in the country accommodating more than 200,000 foreign workers. This is aggravated by shooting cases with mass gatherings in late March, making it the most serious country in Southeast Asia[xv].

There is another curious thing. In the former East Germany region, the death rate caused by the new coronavirus was 0.11; while in the former West Germany region, the death rate caused by the new coronavirus was 0.35. One possible explanation is that East Germany uses the BCG of the former Soviet Union, while West Germany uses European Version of the BCG vaccine, and in 1998 stopped the universal vaccination. As a hostile neighbor, Iran uses its own vaccines, while Iraq uses vaccines made in Japan. To 30 March, more than 500 people have been diagnosed across the country and 42 died. However, Iran is one of the most severe countries in the world with more than 2,700 deaths[xvi].

IV. How the SK Economy Could Be Reopened

1. Strategy

The strategy should be a gradual, cautious opening with well-planned supports and back-up in order to achieve the highest quality of life while maintaining the safest protocols. Furthermore, in order not to be contaminated, screening measures should be taken to make an area set loose internally yet strict externally. For example, at international arriving terminals and domestic arriving terminals from QC, ON, and BC, forehead thermometers and sanitizing devices should be in place to monitor the travellers, and forms in place to fill in so as to obtain travelling and contact information to keep in track. Similar devices and equipment need to be installed at gas stations near the border between Manitoba and Saskatchewan, between Alberta and Saskatchewan as well as the border between the US and Saskatchewan (please note that data from Canada’s largest provinces show it was American travellers, not Chinese, who brought the deadly virus to our shores with about a third of the confirmed cases in ON and QC being attributed to travel to the US[xvii]). Mass immunity cannot be relied on because people can catch the disease twice or a third time as did a woman in Vancouver[xviii], let alone the ADE effect, in which sustained inflammation, lymphopenia, and/or cytokine storm can be elicited, resulting in severe cases and deaths[xix]. Also, mayors, community leaders, business owners and non-profit organization managers need to be consulted before large-scale decisions are made.

2. Specifics

1) Industries

The industries to be opened first should be those tied to essential services and people’s daily life including the food chain and industrial and commercial logistics, and the last to be opened should be entrainment places, casinos which are not a necessity for the average people yet which can easily spread the disease.

2) Areas

The areas to be opened first can be rural areas, small towns where no cases are suspected and it is hard to spread the disease.

3) Time Schedule

There should be basically 4 stages: a first stage to partially open after a week with the number of cases maintained below 15 daily; a second stage to open more including libraries and churches after a week with the number of cases maintained below 5 daily; a third stage to open more including restaurants, movie theatres and pubs after a week with the number of cases maintained below 0 daily; and a fourth stage with everything open including schools after 2 weeks with the number of cases maintained below 0 daily.

4) Technology

The technology to test as many as possible those in doubt and to keep track of the patients and their contacts is of vital importance. The City of Wuhan has applied an electronic code system. The code called Wuhan Health Code can be used for travel by entering the name and ID number through the mobile WeChat app. Residents present their health codes when entering or leaving the closed community, and the community administrator scans and registers the codes to facilitate travel, medical treatment, and asking for help. Thus, those infected won’t be able to have a chance of spreading the disease.

5) Medicine

According to WHO, to date, there are no specific vaccines or medicines for COVID-19. However, it is found that the traditional Chinese medicine Lotus Qingwen Capsules (with the experiment results showing that the clinical cure rate increased by 12.7%, and the treatment group decreased by 50% compared with the control group[xx]) and Asian BCG are effective in preventing the disease and even curing an early stage COVID-19 patient.

V. Conclusion

The Saskatchewan economy needs to be reopened, but it takes both strategy and skill to make it happen. As put by the proverbial saying, Rome wasn’t built in one day.

瘟疫大流行期间萨省经济应如何重新开放？

摘要：为保​​障经济发展，萨斯喀彻温省政府逐步开放该省的五阶段计划将于5月4日开始。同时，政府要求人们遵守有关距离和安全保护的规定，并仍然禁止大型公众聚会，学校仍无限期关闭。联邦政府制定的重新开放指南要求，新的COVID-19病例和住院人数必须保持稳定，新病例的比率必须“保持在医疗体系可以管理的水平上”，而省级公共卫生体系仍然具备“测试、追踪和隔离所有病例”的能力，具有实施工作场所协议的支持，并采取了“防止病毒在弱势群体中受控传播”的措施。在萨省，病例的每日增加量有时仍大于15个。其次，还有从美国和其他严重省份进口病例的问题。接下来，可能存在我们如何才能确保我们有足够的医疗保健能力，以及我们还能成功地监控和控制这些病例， 还有出现紧急情况或者未预料情况时的备份计划。至于重新开放，放松管制的企业应该是那些能最少触发病毒、而对为经济有最佳经济效益的企业。此外，需要实施一个内部放松、但外部严格的战略，放松时间表在很大程度上取决于案例的缓和情况，尤其是社区传播的案例。首先要开放的区域可以是农村没有可疑病例且难以传播疾病的农村和小镇。萨斯喀彻温省的经济需要重新开放，但要实现这一目标需要好的战略和技巧。

关键词：COVID-19，重新开放，输入案例，监控，备份计划

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[i] COVID-19 in Saskatchewan: 5-phase plan to reopen province set to begin May 4 Morgan Modjeski, CBC News, 2020-04-24. Please also take time to read the full article

https://www.cbc.ca/news/canada/saskatchewan/province-pandemic-reopen-plan-1.5542461.

[ii] Katherine Hill: These are the changes in the updated Re-open Saskatchewan Plan, CTV News, 2020-05-01. Please take time to read for your reference the full article by clicking on the link https://regina.ctvnews.ca/these-are-the-changes-in-the-updated-re-open-saskatchewan-plan-1.4921579.

[iii] Beatrice Britneff: Coronavirus: Officials outline 7 criteria needed before restrictions can be loosened, Global News, 2020-04-29. Please read for your reference the full article by clicking on https://globalnews.ca/news/6879092/coronavirus-officials-7-criteria-restrictions-loosened/.

[iv] Beatrice Britneff: Coronavirus: Officials outline 7 criteria needed before restrictions can be loosened, Global News, 2020-04-29. Please read for your reference the full article by clicking on https://globalnews.ca/news/6879092/coronavirus-officials-7-criteria-restrictions-loosened/.

[v] Jason Herring: Shops, restaurants allowed to open in mid-May as Alberta rolls out relaunch plan, Calgary Herald, 2020-04-30. Please read for your reference the full article by clicking on https://calgaryherald.com/news/live-at-330-p-m-dr-hinshaw-to-update-alberta-covid-19-situation-2/.

[vi] Laura Sciarpelletti: Reopening differences in Sask. and Man. put border towns in interesting positions, CBC News, 2020—05-01. Please take time to read the whole article by clicking at https://www.cbc.ca/news/canada/saskatchewan/sask-man-covid-19-reopening-border-community-1.5550785.

[vii] Saskatchewan Government: COVID-19 Update: Saskatchewan Records Sixth Death, 2020-04-29, https://www.saskatchewan.ca/government/news-and-media/2020/april/29/covid-19-update-april-29.

[viii] Jason Warick: Some Sask. business owners question lack of rules, support around COVID-19 reopening, CBC News, 2020-04-29. Please read for your reference the full article by clicking on https://www.cbc.ca/news/canada/saskatoon/business-owners-question-reopening-1.5548489.

[ix] Yu Li: Hubei is unsealed, and Wuhan is about to keep up, Voice of Germany Chinese Network, 2020-03-24, https://www.dw.com/zh/武汉解封即将跟上/a-52897951.

[x] COVID-19 in Saskatchewan: 5-phase plan to reopen province set to begin May 4 Morgan Modjeski, CBC News, 2020-04-24. Please also take time to read the full article

https://www.cbc.ca/news/canada/saskatchewan/province-pandemic-reopen-plan-1.5542461.

[xi] 11 million people suspending their trajectory, what has happened in Wuhan in 76 days, from the closure of the reopening (in Chinese)? Southern Metropolis Daily, 2020-04-08. Please read http://www.xinhuanet.com/local/2020-04/08/c_1125829572.htm.

[xii] Siying: Difficult choice for Hubei between closure and opening after the "turning point" of pneumonia epidemic, BBC Chinese, 2020-03-13. Please also take time to read the article https://www.bbc.com/zhongwen/simp/chinese-news-51868645.

[xiii] Jeffrey Reeves: Experiences from best practices in Asia show a path forward in the fight against COVID-19, Vancouver Sun, 2020-04-29. Please also take your precious time to read the article https://vancouversun.com/opinion/jeffrey-reeves-experiences-from-best-practices-in-asia-show-a-path-forward-in-the-fight-against-covid-19/.

[xiv] Yuxin Feng: A zero-infection Italian Chinese community: 30,000 overseas Chinese who have escaped the virus (in Chinese), 2020-04-29. Please read the full article by clicking on the link https://view.inews.qq.com/a/20200429A0NDYG00?shareto=wx&devid=E0448F1A-B3D4-4CF5-8D38-4E691379CFE4&qimei=1c73ca17-e3bf-40dd-b87b-0c1735465fe2&uid=100005013231&from=groupmessage.

[xv] Suddenly the second round broke out! What happened to this country with the most diagnoses in Southeast Asia (in Chinese)? China Fund News, 2020-04-25. Please take time to read the full article https://www.sohu.com/a/391180254_465270.

[xvi] Jianjun Dong: Is this the root cause for the European and American epidemic to be more serious than that of Asia (in Chinese)? Across Japan, 2020-03-30. Please also view the article

https://mp.weixin.qq.com/s/NKjjYRJ6FbenrnS1mC9m0A.

[xvii] Ryan Tumility: Canada's early COVID-19 cases came from the U.S. not China, provincial data shows, the National Post, 2020-04-30. Please take time to read the whole analysis by clicking

https://nationalpost.com/news/politics/canadas-early-covid-19-cases-came-from-the-u-s-not-china-provincial-data-shows.

[xviii] David Molco: 'I should be immune by now': Vancouver woman believes she's had COVID-19 at least twice, CTV New Vancouver, 2020-04-30. Please take time to read the whole story by clicking https://bc.ctvnews.ca/i-should-be-immune-by-now-vancouver-woman-believes-she-s-had-covid-19-at-least-twice-1.4920095.

[xix] Tetro JA: Is COVID-19 receiving ADE from other coronaviruses? Microbes Infect, March 2020, https://www.ncbi.nlm.nih.gov/pubmed/32092539.

[xx] Li Yu, Administration of Traditional Chinese Medicine: Traditional Chinese Medicine Lianhua Qingwen Plays an Important Role in Fighting Against COVID-19, 2020-03-20. Please also read https://apnews.com/b95a50ede1b77fa90388b870803d8872.