This is chance Ford shouldn’t turn down
It feels like yesterday we were all eating in restaurants, drinking in bars, hugging one another to show we care. Or it feels like a million years ago, either way. Before COVID-19, it was certainly something we used to do.
Anyway, the point is things change, and on Friday, Doug Ford swerved. A day after saying he wouldn’t consider a regional approach to Ontario’s pandemic reopening, he said he would. And thank goodness, if he means it.
“I think it’s a big province, places are far apart, there’s a lot of success stories in Ontario, and then there’s a lot of challenges in the Greater Toronto Area that are less so outside the GTA. So I think it’s a terrific idea,” said University of Toronto epidemiologist Dr. David Fisman.
“Hopefully there’ll be the ability to support the GTA directly, and get the local medical officers of health the resources they need, and empower them to get the job done within the GTA. So it doesn’t recontaminate everywhere else.”
Indeed: to beat an epidemic you have to complete the epidemic curve, and Ontario’s half-ass lockdown and lack of underlying epidemic response have kept that from happening. The dissatisfaction in the medical community has become a dull roar.
Wednesday, the province’s 34 medical officers of health presented a set of actual measures and thresholds they intend to use to either slow reopening measures, or to reinstitute restrictions regardless of provincial decree. Toronto and the GTA, you see, hold about 41 per cent of the population of Ontario, and 76 per cent of the identified COVID-19 cases.
In response, the premier of Ontario protested feebly Wednesday that people own cars, and that things were going pretty well in Ontario. To which the answer from several medical officers of health had clearly been, not here it ain’t.
On Thursday, Doug said a regional approach was out. And on Friday, he said maybe. Winding road, but we’re getting there.
“There’s never a light bulb that goes off in my head,” said the premier, on what had changed. “I take the advice … I’m no health expert: I rely on health and science. I’m not going to go against the medical professionals on this.”
Well, except for the reopening decision, maybe. The science hadn’t changed an awful lot in those 24 hours, but chief medical officer of health Dr. David Williams can take five or six different turns in the same meandering sentence to nowhere, so who knows.
Ford’s reasoning for this regional consideration seemed specious: a few days of above-15,000 testing, which has happened several times earlier in May. And his specifics remained nonexistent, which is the problem the medical officers of health were trying to rectify.
“We need confidence in our government, and when there’s transparency you create an environment where people can be confident in your actions,” said epidemiologist Dr. Nitin Mohan, who teaches public and global health at Western University, and who co-founded a public health consulting firm called ETIO.
“When there’s a lack of transparency to the point where epidemiologists are wondering what the rationale (for reopening) is, it can lead to the disintegration of confidence and hopefully not noncompliance with the measures you’re still asking for.”
And no, Ford didn’t mention the MOH plan, which has been widely praised by respected epidemiologists. But his government also plans to eliminate said medical officers of health, in what is likely a misbegotten idea. It’s probably not politically pleasant to concede power and authority to people your government intends to disempower so you can have the authority.
But hallelujah, maybe. The province needs different approaches, and it’s been clear for a while. Deriding local health units as fiefdoms ignores successes in Kingston under Dr. Kieran Moore, in Sudbury under Dr. Penny Sutcliffe, and more. And Ontario’s epidemic primarily lives in the GTA. We need different rules.
“We have a different situation here,” said Toronto Mayor John Tory. “That kind of consideration from him is most welcome.”
So let’s go. Ontario’s response to this pandemic has been sclerotic. Ford promised testing of vulnerable populations like homeless shelters or refugee centres on April 10; he reannounced it Friday, as part of a testing plan that until two weeks ago was still sending away people with symptoms for not having a referral.
“I appreciate that there’s great diagnostic capacity right now, and it took until late May to have a policy where people with signs and symptoms compatible with COVID-19 could go to a testing centre and get tested,” said Dr. Isaac Bogoch, an infectious diseases specialist with the University of Toronto and Toronto General Hospital. “I’m really happy it’s happened, but let’s be clear: it’s late May.”
Ford also announced 2,000 contact tracing hires on Friday, on the same day Dr. Michael
Warner of Michael Garron Hospital in East York felt the system fail. Thursday night Warner saw a patient with COVID-19 who lives in a big apartment building and has a customer-facing job. Warner was told at 9 p.m. by Toronto Public Health contact tracing would begin, and found the next morning it had not. Contact tracing is another basic of epidemic response Ontario hasn’t come close to mastering.
“If you don’t start immediately, there’s no point in doing it,” Bogoch said. “They did Ebola contact tracing of 25,000 in a war zone in the eastern Democratic Republic of Congo. We can do it in the GTA.”
And beyond the long-termcare disaster and worries about retirement homes, there is still no meaningful public support for isolation facilities for the people hit hardest by this virus: the people who live in lowincome areas, who likely got the virus in their workplace, and who can’t isolate themselves from their families. Again: it’s late May.
Still, testing might finally have a chance. We likely still need one hell of a person in charge of this thing — a czar who can truly align the premier, the mucked-up overlapping health system, epidemiology and public health.
But finally Ford has accepted that maybe we don’t have to treat every part of Ontario the same, and that’s a start, even this far gone. Our medical officers of health offered this province a steering wheel, and a windshield you can see through. They offered the premier a non-political, scientific win that could benefit everybody.
It was a gift, in the pandemic. And he should take it.