Ontario too timid to move to endgame

BY MID-MARCH, WE'LL ROUGHLY BE BACK TO WHERE WE WERE. — SUBRAMANYA

Ontario Premier Doug Ford announced Thursday a partial rollback of his ill-advised and unscientific lockdown which by his own say so took him “30 seconds” to decide on. While masking and social distancing rules remain in force, gyms, theatres museums, and restaurants will be allowed to reopen at 50 per cent capacity. By midMarch, Ontario is expected to lift other capacity restrictions but indoor gatherings will still be limited to 50 people starting Jan. 31.

In other words, in a few days we're not even going back to the freedoms we enjoyed last fall, but we're once again under “circuit breaker” conditions, defined by the Ontario Science Table back in December as a reduction in contacts by 50 per cent and an accelerated booster roll out. By mid-March, we'll roughly be back to where we were, but significantly we don't have an explicit road map to a full return to normalcy and the present relaxations could be reversed if the premier doesn't like where cases are going.

The premier's about-face is no doubt motivated by a host of factors, including a public backlash and plummeting poll numbers ahead of this spring's election. He and his advisers may also have been influenced by the fact that the Omicron wave appears to be peaking worldwide, including in Ontario, with hospitalizations and ICU admissions stabilizing.

As evidence, the Ontario Hospital Association releases daily data on hospital capacity, which is publicly available. As of Jan. 18, the last day for which we have data, COVID-19 patients in ICU “throughput” is about one. In other words, the number of patients discharged from the ICU (that includes deaths) is roughly the same as the number being admitted, so that the number of patients in ICU is approximately constant over time, easing pressure on ICU capacity. As a benchmark, on Jan. 9, the throughput was about 0.5, meaning about double the number of patients entering as leaving the ICU. Meanwhile, the median ICU stay has also more or less stabilized at seven days, way below the August of 2021 peak of around 60.

With little if any appetite for further lockdowns by a beleaguered public, attention is turning to the around 1.5 million Ontarians who have not been vaccinated. Quebec Premier François Legault has already taken the unprecedented decision to “tax” the unvaccinated to make up for the presumed extra burden that they place on the hospital system. While no such plans have been mooted by the Ontario government, a recent MARU poll suggests many Canadians appear to support harsh and punitive action against for those refuse to get their shots, including 27 per cent who would even support jail time for up to five days.

While such harsh measures are unlikely to survive a legal challenge if they're attempted, it's evident there is an attempt to scapegoat the unvaccinated as the sole reason why Ontario's hospital system is under strain. While it's true that unvaccinated COVID-19 partiers are disproportionately filling up ICUs, it does not follow therefore that they're a singular cause for our current woes.

There are structural defects in the hospital system that haven't been rectified since the onset of the pandemic almost two years ago. For example, as of Jan. 17, 42 per cent of those awaiting transfer to long term care facilities were unable to find a placement, using up valuable hospital resources through no fault of their own. This amounts to about 2,200 people, and the median wait for an LTC placement for someone in the hospital is a staggering 114 days, according to Health Quality Ontario.

The fact that there's no placement available for these patients in the LTC system is a drain on hospital resources, for which neither they, nor for that matter the unvaccinated, are to blame. This is only one of a litany of failures in the public health system which have nothing to do with COVID.

There is some precedent in the advanced world for countries either imposing vaccine mandates or attempting to tax or sanction the unvaccinated. Both Austria and Germany have announced vaccination will become mandatory, but in both countries there are major logistical issues and legal challenges that lie ahead.

Mandatory vaccination, as opposed to the passport systems currently in place, would be the more honest, if politically riskier approach. However, such rules might not survive constitutional challenge, and is surely why most jurisdictions in the Anglo-American sphere have refrained from truly mandatory vaccinations, and instead attempt to cajole people into get vaccinated by making life difficult or impossible if they don't. The limits to this backhanded approach are obvious. Recently, the U.S. Supreme Court overturned the Biden administration's mandate that workers at large corporations had to be vaccinated.

The question no one is asking in Canada is why we're still debating lockdowns and school closures and not moving decisively into an endgame of the pandemic, with other countries far ahead of us. The vast majority of credible experts, leaving aside the perennial doomsayers, are now saying that the end of the pandemic is in sight. Yet Ontario's government appears to be in perennial crisis mode.

Not only are Ontario's restrictions stringent by world standards, they're even stringent by Canadian standards. The Bank of Canada has constructed a COVID-19 stringency index going back to the beginning of the pandemic and it shows for almost the entire period, Ontario's restrictions have been more stringent on average than the whole of Canada. That's a dubious record to hold and Thursday's announcement is unlikely to change it.