The going assumption up here in Canada is that the border won’t reopen with the US until 2021, or maybe until the pandemic is over (whether that’s via vaccine or herd immunity, anyone’s guess).
Your TL;DR is that the math on how the virus is going in each country tells an interesting story, but I’d argue that the spread of COVID in the US is probably at least 4x higher than in Canada, and widening now that Canada has gotten past the first wave, while the US hasn’t.
Let’s take a second to consider some numbers on the impact of the whole pandemic to date. Deaths per capita are higher in the US by a ratio of 408:232. Infections are higher by a ratio of 96:28.
Both rates are quite off, but the death rate is considerably closer. One piece of general context is just that Canada is older: the average age in Canada (42) is closer to Italy (44) than the US (38). But to fully explain this, you have to understand precisely where and how COVID hit Canada.
Quebec is the epicenter of Canadian COVID. Quebec has 23% of the Canadian population, and 64% of Canadian COVID deaths. 80% of Quebec deaths took place in nursing homes. That’s probably because Quebec has a massive nursing home population, and they were completely unprepared. Almost 2% of Quebec’s population is in nursing homes, five times higher than the overall US rate of 0.4%. That’s huge, and in my mind the most underreported stat for understanding the comparative impact of COVID in these countries. In general, it’s nice that the province offers enough funding to create a lot of spots in long-term care. What the province doesn’t offer, though, and especially didn’t offer here, is regulation. A lot of contractors get a cheque per resident from the province and no meaningful oversight. So even as any common living environment was poised to become a COVID hotspot, nursing homes did little to protect themselves. They did not prepare to function as quarantines, their chronic understaffing issues were exacerbated by the crisis, and so more workers were serving multiple homes at the same time, becoming walking vectors from one outbreak to the next. For the government’s part, all the attention went to preparing hospitals, which ended up doing fine. Literally the most vulnerable population, health-wise, was left the most vulnerable to transmission. Combine that with the higher numbers of people in long-term care overall, and the death rate in Quebec nursing homes drove the death rate for the whole country. The crisis was underscored when the army was sent in to staff the worst of these homes. That’s the story of Canadian COVID: soldiers staffing nursing homes that became disease magnets.
In my mind, those facts are the difference between a 4:1 infection rate and a <2:1 death rate. If you could normalize for how hard COVID hit that 2% of the Quebec population in long-term care, I think you might see that the other 98% of Canada is in a much different situation, infection-wise and death wise, than the US.
The instinctive response to a divergence between cases and deaths is to blame testing, but I don’t think that argument has a leg to stand on here. Yes, the US is now testing more people per capita overall than Canada, but they missed the whole prevention window, not hitting reasonable testing numbers until mid-April or May. Meanwhile, Canada’s lower testing numbers right now are driven by lower demand. You see this in the positive testing rate: nationally, Canada has gotten back down under 1% positive test results, while the US is up at 8%. Anecdotally, you see this when the premier of Quebec has to plead with people to go get tested. Quebec has largely given up on hitting its testing goal, not for lack of tests, but because there haven’t been enough people a day going to the sites. So when the national curve has fallen to a small fraction of its peak and the positive rate is at 1%, you can safely say that Canada’s testing regime is doing its job.
That means that the situation in these two countries really is divergent, and the 7 day rolling average on cases and deaths underscores that it’s widening. The difference in the 7 day death average is about 4:1 right now. The case rate difference is wider. The US added 379,851 cases over the last week. Canada added 2,163. That’s a per capita ratio of 20:1, even as Canada gets an 8x lower positive test rate.
Now, 4:1 and 20:1 are also notably off, and there’s multiple ways to try and interpret that. One is that the US is at the beginning of a larger wave that hasn’t translated into deaths yet. People drag on for a month with this disease sometimes. One is that we’re developing better treatments, and the death rate is dropping faster in the US, for whatever reason, on account of that. Another is that the US is seeing a much higher percentage of its young people getting the disease as it reopens. If the newly reopened nightclubs are the largest vector, your death rate will be way lower than if it’s home health aides.
But if I have to explain the difference between a 4:1 ratio and a 20:1 ratio, I’ve already gotten to the point where the argument is moot, and it’s obvious that the situation is being controlled very differently in Canada and the US. And that makes me think that we might not see the end of this border shutdown until well into 2021, or until a vaccine is widely distributed.
In spite of all of this, I don’t think Canada got to where it did by draconian restrictions. I can walk down the street today and see many people without masks, and mandatory mask policies are generally intermittent around the country. We have picnics in the park at a 2m distance from our friends, we’ve started having small indoor gatherings with another family or two. If you’re looking for signs that Canadians individually behave massively differently or are enthralled to some COVID authoritarian, I don’t see it.
Rather, I think the difference you see isn’t what we’re doing today, but what both countries did in March. Both countries started in the same spot. We got our first cases the same week. We’re almost identically urbanized by population. But while nursing homes took a huge blow, the community transmission rate through the rest of Canada was just lower overall because of widespread coordination on distancing, testing, and tracing.
When the case numbers get as high as they are in the US, it’s not the result of how people behaved yesterday. It’s not even a result of how people behaved two weeks ago, when they caught the disease. It’s how the whole country behaved for a couple of months to allow the disease to spread far enough that you could have the conditions laid for mass community spread everywhere at once.
That’s why I don’t think the border is going to open up until this is over (or if it does, at least, it won’t be driven by health — I wouldn’t be surprised to see Trump threaten Canada somehow to get the border open before November, so who knows). Regardless of what people start doing tomorrow or who wins the election or whatever, there’s a huge gulf in how prevalent this disease is at this point on either side of the border, and you can’t put that genie back in the bottle.