`New normal' in Ontario won't be cheap

Budget still won't be enough to help everyone

Ontario's budget landed on Thursday, not with a bang but a whimper. By any non-2020 standard, it's a horror show: To the previously projected $38.5-billion deficit in 202021 you can now add $33.1 billion in 2021-22 and $28.2 billion in 2022-23, all of which will ratchet the province's debt-to-GDP ratio to very nearly 50 per cent. The balanced-budget target, which had not been very ambitious to begin with, has been fired out of a cannon into the sun. And it won't be nearly enough to get every Ontarian through this pandemic unscathed.

In the lead-up to the budget, Premier Doug Ford and Finance Minister Rod Phillips had been talking up improvements to the province's system of long-term care homes: Increasing “direct daily care” provided to residents from 2.7 hours to four, and recruiting thousands more personal support workers. These were among the interim recommendations issued last month by the Long-Term Care COVID-19 Commission, created by the government in May to examine the catastrophe that swept through so many facilities in the spring.

There is no costing for those measures in the budget, however. “The challenges of finally fixing our long-term-care system are complex,” Phillips explained. In the absence of hard figures, NDP opposition leader Andrea Horwath expressed doubts about the Tories' ambitions. In the long term, improvements are the most important indicator to watch to determine whether the government is serious about preparing for next time.

It's important to watch in the short term as well, mind you. The budget lands in the same week the Ontario government signalled that it's done shutting down indoor dining, gyms, cinemas and other congregational businesses, barring unprecedented disaster. Such businesses will be allowed to reopen over the next 10 days in the four public health regions where they were shut down last month, despite three of them seeing higher new case counts now than then.

The government didn't say it was backing off, in so many words. But under its new colour-coded four-tier system, a public health region would need to see more than 100 cases per 100,000 population per week before the province again shut down indoor dining. No Ontario public health region has yet seen a week that bad.

This has been as poorly received by most infectious disease and public health specialists, and media commentators, as you would expect. And the government's focus on improving standards at long-term care homes hasn't done it any good in that arena. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, got many positive notices for a Twitter thread in which he derided the government's approach as “nothing more than an ageist, ableist and unethical `shielding' or `focused protection' strategy.”

Protecting “the oldest and most vulnerable … while allowing everyone else to resume life as normal with simple hygiene measures” is unconscionable, he argued, because “without a strategy to suppress community transmission and strive for elimination of COVID-19, we will be committing LTC residents … to indefinite, harmful and deadly confinement.”

It's a baffling argument. Firstly, whatever one thinks of the Ford government's restrictions on society and commerce, they hardly amount to “life as normal.” Secondly, we know that 89 per cent of Canadian fatalities have been over 80, and that roughly 80 per cent have occurred in long-term care homes. What happened in the spring at far too many of those homes, to far too many of their residents, was to Ontario's and Quebec's everlasting shame. To focus on protecting those homes and those residents now is definitely not.

Obviously the surest way to keep COVID-19 out of long-term care homes is for there not to be very much or any COVID-19 outside waiting to come in. But as I wrote earlier this week, there is simply no reason to believe Canada is capable of “eliminating COVID-19” in the way places like New Zealand or Australia have. You can go ahead and wish otherwise, but that won't make it so. We can only play the cards we have.

Absolutely a “protect the vulnerable” strategy imposes stress on the vulnerable (though less, I would hope, than a “don't protect the vulnerable” strategy). But that stress can be managed with, among other things, more direct daily care from happier full-time staff who aren't constantly changing jobs or juggling multiple gigs. It can be managed with carefully controlled visits by properly tested family members who take the proper precautions. It can be managed with better facilities, period. Some of those things will take time to accomplish.

I don't begrudge a geriatrician advocating for the geriatric. One cannot downplay the fear, loneliness and confusion so many elderly Canadians have experienced over the past seven months. But Statistics Canada estimates there are 1.7 million Canadians aged 80 and over, and 34.4 million Canadians between the ages of five and 79. A great many of the latter are suffering as well. Protecting the most vulnerable and allowing the rest to cautiously pursue some semblance of normalcy isn't just entirely ethical; at some point, if bestcase scenarios don't come to pass, it will be the only economic choice we have.