Why we don’t know more about where COVID-19 is spreading in Ontario
Data on bars, gyms, stores, churches is not available
Doug Ford stared out from behind his podium and gave the province his best disappointed dad glare. He fumed and shook his head. “If we weren’t so backlogged on the MRIS I’d send you to the MRI to get your brain scanned,” he said, channelling Red Forman from That 70s Show. “Because I don’t think there’s anything in there.”
Ford was lecturing, via press conference, the organizers of a car rally held in Hamilton last weekend. Several hundred vehicles turned up, and the drivers spilled out and milled around in tight clusters without masks. “I’ll tell you, if they had brains they’d be dangerous,” Ford said. “It’s just unbelievable. Guys, get your act together.”
Ford spoke that day, as Ford does, in his own unique way — like a suburban father who just busted some teens doing whippets behind his shed. But the tone and content of his scolding were familiar to anyone who’s been following Ontario news.
Ever since COVID cases began creeping up again in Ontario, political leaders and public health officials have been speaking out with increasing exasperation and focus about large social events that could be driving the surge.
Toronto Mayor John Tory decried a Scarborough house party as “incomprehensible” and “inconsiderate” Wednesday. Ottawa Public Health released a graphic Tuesday that showed how a 40- person park party was tied to an outbreak that shut down two daycares and spread to several schools.
In London, it was partying students. Elsewhere it was a cottage full of friends. But everywhere the message was the same: If you knuckleheads don’t smarten up and do the right things, the whole province could be shut down again soon.
But despite the blanket messaging, the endless press conferences and announcements, actual, specific data on how and where COVID is spreading in Ontario remain surprisingly sparse. “That is the biggest issue right now: We don’t know where these cases are coming from,” said Ryan Imgrund, a biostatistician at Southlake Regional Health Centre in Newmarket.
Local public officials in the hardest hit parts of the province — Toronto, Ottawa and Peel Region — all spoke out with real urgency this week. The message, from all of them, was similar: Ordinary Ontarians need to do more now to slow the spread of COVID- 19. But outside experts worry that many in the province still don’t have enough information to know what exactly they should be doing differently.
“You’re asking people to change their behaviour, but we haven’t been given information about, OK, where are the high- risk environments?” said Dr. Ashleigh Tuite, an infectious disease epidemiologist at the University of Toronto. “Most of the insight that we gain is basically through press conferences or press briefings, where we hear off the cuff remarks about … Right now it feels very black boxy.”
One worry from outside experts is that all the focus on big parties and wild events might be creating a false sense of complacency among the less party prone. Just because you aren’t going to keggers, that theory goes, it doesn’t mean your big family dinner is safe.
The bigger problem, though, is that after months of lockdown followed by a wide summer release, many people don’t really know what’s safe and what isn’t. The provincial and local messaging on things like bubbles and social circles has always been confusing. Now it’s outright contradictory. The province also doesn’t publish aggregated, specific data on the kinds of places where people are contracting COVID-19.
On Friday, the province’s chief medical officer of health ordered strip clubs across Ontario closed. He also imposed new, stricter dining and drinking hours. Ontario restaurants and bars can no longer serve alcohol after 11 p. m. No one, including staff, can consume alcohol inside a restaurant or bar between midnight and 9 a.m.
Those new rules may help, experts believe. But they don’t change the fact that ordinary Ontarians still don’t know how many cases have actually been linked to restaurants or bars. They don’t how many were acquired at weddings, churches, temples or mosques. There’s no data on funerals. There’s none on gyms, grocery stores or garden parties. That’s all information that could help people make smart decisions about their lives, said Dr. Tera Kiran, a family physician and health policy researcher at the University of Toronto.
“I would love for us to have that data and to make it public,” Kiran said. “And I think that could then inform not just individual action, but obviously it could really inform government policy and public health interventions too.”
Some public health officials are sympathetic to those calls. “We are working at our level best to get a lot of this data out there,” said Dr. Lawrence Loh, the medical officer of health for the Region of Peel. “It’s been a challenge because our epidemiologic and our data systems resources are limited.”
Part of the issue is that the set categories in the provincial database don’t capture that level of granular detail, said Dr. Vera Etches, Ottawa’s medical officer of health. “We don’t have a little category for gyms. And so we have to pull that out of the nursing notes and we are looking at how to do that.”
Loh said that, in general, in Peel — a cluster of densely populated suburbs outside Toronto — cases are coming from three kinds of locations. “It’s basically a cycle right now that’s just going between workplaces to homes, to social gatherings,” he said.
The transport, warehousing and manufacturing sectors in Peel have been particularly hard hit, Loh said. In the trucking industry, they’ve seen clusters tied to work, like loading and unloading trucks. In other cases, across all industries, they’ve found employers that just aren’t doing enough to keep their workers safe. “We need to have more proactive workplace inspections,” Loh said.
As a next step, Loh would like to see the province look at new restrictions on banquet halls and places of worship. “We’ve seen a lot of outbreaks associated with weddings and funerals,” he said. “Maybe we need to revisit how we’re doing those.”
One place Peel hasn’t seen many outbreaks is in restaurants. In fact, Loh said, he couldn’t think of a single case that he knew of where a server had passed the virus on to a customer or vice versa. “If I was seeing that I would absolutely be (saying) let’s look at the restaurants and bars,” he said. “My impression is that the industry is so focused on making sure that they stay open, that they have taken all kinds of precautions to limit their interactions.”
That’s not to say restaurants and bars have been perfect. They haven’t. Where Loh is seeing problems is between staff members themselves. “It’s after the restaurants close down and the staffers are sitting around and having their dinner, that’s where we’re seeing transmission,” he said.
For ordinary people, Loh said, the message is the same as it has been for months. It’s just more urgent now. Wear masks indoors or when you can’t keep your distance. Wash your hands. And above all, limit your close contacts. “Whatever circle or bubble or concept that someone is subscribing to, we need to shrink that now,” he said.
The provincial government hasn’t changed its guidance on “social circles” since introducing the concept in June. But local health officials have largely stopped talking about the idea.
“I don’t think the social circle concept has worked out, when I look at what we’re seeing in people’s behaviour, where one circle of 10 becomes a different circle of 10 overlapping on different days of the week,” said Etches. “The concept was that you need to limit your contacts. It can’t be different people all the time.”
In Peel, the data on how just badly the social circles idea has broken down is particularly stark. “We used to have people who were reporting just five close contacts when we were doing contact tracing,” Loh said. “They’re now reporting an average of 25 to 30 contacts.” That’s just an average, too. “We know there’s some people that are lower than that, and there’s some people that are way higher,” Loh said.
For Dr. Eileen De Villa, Toronto’s medical officer of health, the question of where people are getting COVID is almost irrelevant. “As it turns out, COVID-19 doesn’t come from a place,” she said. “It comes from one person to the next, right? That’s how the virus spreads.”
De Villa thinks ordinary Ontarians have more than enough information right now to do what’s right. “Fundamentally COVID- 19 is about the behaviours that people engage in,” she said. “And that’s why you’ll hear me say time and time again, please limit your contact with people that you don’t live with.”
Still, others believe that more information would help. Kiran, for one, would like to see aggregated data published that shows where the virus is spreading — whether it’s in gyms, bars, private gatherings, churches or offices. “I would say in general, in a pandemic,” she said, “I think we should be weighing on the side of transparency.”
We don’t know where these cases are coming from.