Cases are trending downward but reopening is a roll of the dice, risking the slow start of a third wave.
It could be worse. That’s an underrated lesson of human history, but in Ontario it’s also been an official pandemic talking point. Look at Quebec, or Manitoba, or the United States. The bar may be stapled to the hospital floor, but it’s true: it could be worse.
And when you consider Ontario’s new plan for reopening the province, that assessment applies. On the one hand, it was a proposal to unknot the only combination of policies which have bent Ontario’s epidemic curve since last September. On the other, it was not simply throwing open the doors and declaring mission accomplished. And as demonstrated by the ill-fated framework unveiling back in November, in Ontario, that kind of thing is a possibility.
“There’s no question that these lockdowns and all these restrictive measures have helped,” said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto, and the medical director of the Antimicrobial Stewardship Program at Sinai Health System-University Health Network, speaking of the Boxing Day lockdowns and January stay-at-home order. “And there’s also no question that everything else leading up to it did not work.
“And when they loosen up restrictions in places more densely populated than Prince Edward County, we’re going to see another surge. And when you add in the variants, it’s going to grow exponentially. It’s hard to imagine otherwise.”
Indeed, it’s not this week you worry about, when PEC, Kingston-Frontenac and Renfrew go back to green. On Feb. 16 the stay-at-home order is scheduled to lift in 28 regions, and on Feb. 22, Toronto, Peel and York. The province is lifting the ban on non-essential shopping even in grey lockdown zones, too, though with capacity restrictions.
By themselves, those probably aren’t epidemiological earthquakes, but they could add up. We learned a lesson of intraregional mobility from the pre-Christmas patchwork; we don’t know what this will do, but combined with reopening schools — which will muddy the data again on what works and what doesn’t — the decline in cases probably ends soon.
“Numbers probably go up, because they’re not going to go down,” says epidemiologist Dr. Ashleigh Tuite of the University of Toronto. “You’re increasing the number of contacts. When you relax restrictions the message people get is things are less serious.”
“Reopening non-essential business in lockdown, with the variants here and the vaccines not, that says it all right there,” said one health source with a deep knowledge of the pandemic, who asked for anonymity to avoid provincial blowback. “How does ‘stay home’ fit with ‘go shop’?”
It’s all happening against a backdrop that is blessedly improving. Province-wide case numbers continue to fall, finally, though Toronto’s reporting system was mucked last week, and is back online Monday. After a delay, long-term care could be fully vaccinated by the end of February, or sooner. The variants seem to burn slow, before they burn fast.
But this is a roll of the dice to juice the economy, because this government decided not to wait and drive the cases down further. You can see the resistance in the city, where medical officer of health Dr. Eileen de Villa was cool to the hopeful timeline for Toronto.
“I think it’s difficult to talk about particular times, and I would encourage people not to look necessarily at certain timelines,” said Toronto medical officer of health Dr. Eileen de Villa, at a briefing update. “What we want to see is ongoing reduced transmission of the virus, and we’d like to see that as low as possible.
“I think if you look at the jurisdictions that are a little ahead of us ... they’ve said extra caution is absolutely needed, given that the measures do have impact, but given that increased transmissibility associated with these variants, the issue is you have to be extra vigilant around self-protection measures, and public health measures.”
And that highlights the essential divide between truly serious public health measures and the province’s semi-wishful thinking, based on best-case scenarios. Both of the more transmissible variants, those that originated in the U.K. and South Africa, have been found in Toronto in cases not connected to travel; the variant that originated in Brazi, connected to travel, also turned up. Barrie reported 36 new cases of the variant that originated in the U.K. Monday, with another 59 suspected but pending, which may no longer be cases from the Roberta Place LTC outbreak. That’s something to watch.
On variants we have limited surveillance, and still-slow screening confirmation times, and the cases we’re finding are from 10 to 14 days ago. Which spread even with lockdowns, and a stay-at-home order.
“The thing that scares me is we have this process going on that we can’t really see,” says Tuite.
“We know that in a very short period of time, we’re going to need to be revisiting these numbers, right?” says physician epidemiologist Dr. Nitin Mohan, who teaches public and global health at Western University, and who co-founded the ETIO public health consulting firm. “And if we can add paid sick leave, that would be a huge boon.”
But that’s not happening, even as retail opens back up.
It’s a risk. Meanwhile, ICUs are still crowded, and the intrahospital patient transfer system that was intended to relieve pressure in hot spots has been strained in places by variants and by patients unwilling to provide consent. And we are being asked to believe that this government — that Premier Doug Ford and Dr. David Williams — will be fast and aggressive enough with an emergency brake that sends regions back to a grey zone, which is like the old grey zone, but with fewer restrictions.
“We’ve seen some bending of the curve,” said Williams, Ontario’s chief medical officer of health. “And yet as the premier said and no doubt Minister (of Health Christine) Elliott would add, that number is not down yet where we need it. We’ve stepped back from the brink, and some ICUs are still having challenges with moving people.
“This is not an opening up. This is a stepping back into the framework.”
But as noted by Morris, the framework — even the less lunatic version that was eventually adopted — didn’t work before, and that was without variants. And next week, we loosen up.
It could be worse. But it’s still a roll of the dice, risking the slow start of a third wave, with the vaccine supply on pause until later this month. “Today,” said Ford, “we’re seeing some sunlight come through the clouds.” Let’s hope the weather doesn’t change.