Early in the pandemic, New Brunswick health officials often lauded the “layered approach” to managing risk, noting that no tool in the toolbox was one hundred percent effective. Protections such as masking, distancing, hand washing, and staying home when sick work best when practiced in unison. At no point in the pandemic has a magic all encompassing solution presented itself.
Enacting a group of personal and communal protections is beneficial since errors in one protection can be offset by another. This is often cited as the “swiss cheese” model of managing error and effectiveness.
This concept is attributed to cognitive psychologist James T. Reason who argued that human approaches to mitigation are naturally fallible in design and prone to some degree of error in practice. The more layers to the protective model one has, the less likely it is the precise series of errors will take place and result in catastrophe.
The model was perfect for illustrating the multi faceted human approach to the SARS-CoV-2 pandemic. In December 2020, the New York Times wrote about the model:
The metaphor is easy enough to grasp: Multiple layers of protection, imagined as cheese slices, block the spread of the new coronavirus, SARS-CoV-2, the virus that causes Covid-19. No one layer is perfect; each has holes, and when the holes align, the risk of infection increases. But several layers combined — social distancing, plus masks, plus hand-washing, plus testing and tracing, plus ventilation, plus government messaging — significantly reduce the overall risk. Vaccination will add one more protective layer.
In New Brunswick, we followed this approach to internationally recognized success, until our Government decided the pandemic was over, and only one cheese slice was required; vaccination.
As we’ve written previously, vaccinations are amazing, but they are not a silver bullet to end the pandemic.
The strength of COVID vaccinations is in their ability to reduce the impacts of infection, vaccinations are not guaranteed to prevent transmission. Transmission is more effectively prevented by other cheese slices in the model such as masking, ventilation, staying home while sick, and mandated isolation and border controls; all measures which have been abandoned in favour of vaccination.
Public Health's insistence on vaccination as a way to "live with covid" belies the situation we are in.
Even a 100% vaccinated population will be susceptible to mass disease and surplus death in the face of the evolving virus.
We can see how the vaccines-only policy played out in New Brunswick with the Delta and Omicron waves.
98.8% of total NB cases were recorded after vaccines were available.
94.3% were recorded after NB achieved 75% double vaccination rate.
86.8% were recorded after boosters became available.
Similarly, we see that with a vaccine-only policy, deaths slow but do not cease.
97.7% of total NB deaths were recorded after vaccines were available.
86.8% were recorded after NB achieved 75% double vaccination rate.
67.3% were recorded after boosters became available.
Continuing without a requirement for any of the other protections listed in the Swiss Cheese model assures that cases will continue unabated. We have seen first hand that unmitigated transmission leads to more loss than is morally acceptable.
How Do We Move Forward?
The spirit of the Swiss Cheese model is demonstrated in calls for a "vaccines-plus" policy.
Global vaccination
Acknowledgment of airborne transmission
High quality masks when needed
Ventilation/filtration
Effective testing
Transparent, factual communication
Clear criteria for when to use each measure
NB Public Health has never officially acknowledged airborne transmission; they have crippled and undermined effective testing programs; they have stated no criteria for implementing mandated or personal mitigations; and despite their stated sole reliance on vaccines, they have discontinued RHA vaccination clinics.
Vaccination rates are a beneficial scapegoat metric because they transfer responsibility and accountability away from Public Health and onto individuals. New Brunswick Public Health asks us all to bear unprecedented illness while we wait for vaccination rates to increase, but when/if they do, nothing will change.
Vaccine-only policy is bad policy.
If the goal is to establish a "normal" world where we all "live with covid", that world must have multiple layers of non-pharmaceutical protections that are widespread and made equitably available to all New Brunswickers.
Vaccine-only policy will not deliver this world to us.