Fall plan better be worth the wait
What is Ontario waiting for? The province says its fall pandemic plan has been ready since July, but that it is being rolled out in instalments this week because it is so robust, so vast. Despite rising COVID-19 case counts, testing failures and escalating levels of alarm, step one wasn’t revealed until Tuesday, and it was to get your flu shot. Great, good, get your flu shot. What else?
“We don’t have anything specific that we’re prepared to move on right now,” said Health Minister Christine Elliott on Tuesday, “but we are looking very carefully at several different scenarios.”
“This is time for the full-court press,” said Dr. Isaac Bogoch, infectious diseases specialist at the University of Toronto. “On all fronts. It’s go time. It was go time a month ago, but it’s really go time now.”
The province had months to prepare, and it apparently isn’t done yet. Two weeks ago, Ontario shelved further reopening plans as if that was a containment strategy. Last week, Ontario dropped gathering sizes from 100 outdoors and 50 indoors to 25 and 10, though not in commercial establishments, houses of worship or schools. Which was something, but not enough. Maybe not even now.
“I don’t think the social circle concept has worked out,” said Dr. Vera Etches, Ottawa’s medical officer of health. “I look at what we’re seeing in people’s behaviour, where one circle of 10 becomes a different circle of 10 overlapping on a different day of the week.”
That is a failure of public health messaging and regulation, and matches data in Peel, which is another of the hardest-hit regions of the province. They aren’t seeing undifferentiated community spread yet, but it’s not too far from here to there.
“Each case had an average of five close contacts at the end of July and August. Nowadays, that average is up to 25-30 close contacts,” said Dr. Lawrence Loh, Peel’s medical officer of health. “So just by the gross numbers alone, the risk of transmission is increasing.”
So for the moment, it is left to local officials to take action. Tuesday, Ottawa Public Health took the extraordinary step of imposing mandatory 14-day self-isolation on anyone who has COVID-19 or symptoms of COVID-19, is a close contact of someone with COVID-19, or has reasonable cause to believe they have the virus. Violators are subject to a $5,000 fine. You’re allowed out after 14 days, or with a negative test.
Of course, Ottawa’s testing waits have been dystopian, among other reports of lengthy delays in many locations across the province. Premier Doug Ford keeps saying the system is strong and they’re pulling out all the stops, but the lineups are there for all to see.
In the Ottawa Public Health briefing, Jeffrey Dale, the CEO of the Eastern Ontario Regional Laboratory Association, was asked what he needed to be able to handle the testing crunch. He said more reagents, more equipment and more staff. That doesn’t sound like the system was ready.
Meanwhile, Toronto Public Health is only getting 25 per cent of positive tests results from the lab within 24 hours of a positive test, and it is getting less than 60 per cent within 48 hours. Contact tracing capacity has been built up across the province, but as one local medical officer of health who requested anonymity put it, there isn’t a lot of room left on the cliff.
“We still don’t have a realtime data sharing platform for (data transmission from labs to public health),” says Toronto Councillor Joe Cressy, the chair of the Toronto Board of Health. “So from a contact tracing point of view, when you’re trying to manage cases during reopening, we’re starting with our hands behind our back.”
Then there are the testing delays themselves. Like so many in a period of what is now exponential case growth, health-care workers with kids in school have to sit home and wait for tests. The worry is that as hospitalizations inevitably climb, hospital staffing could be impacted.
“The lab capacity for that guy who wants to go to the wedding is the same lab capacity that I use so I can take care of ICU patients,” says Dr. Michael Warner, the critical care chief at Michael Garron hospital in East York, who has already spent three days at home while waiting for a test. “And our turnaround time in my hospital is up to five days. So the supply of the health system is going to evaporate, just as the flu season is coming. So we are in major, major trouble.
“If we didn’t fix (protective personal equipment) in March, everything would have fallen apart. If we don’t fix testing now, everything will fall apart, except much faster.”
So what is the province waiting for? Dr. Ashleigh Tuite, one of the province’s best infectious disease modellers, notes that research out of Switzerland estimates that for every week you wait during exponential spread, you pay a heavy price.
“For every week you wait (to intervene), that’s three weeks of lockdown just to get back to that point,” says Dr. Tuite. “Nobody wants to go back to lockdown. That’s not a good place to be. But if we’re going to get shut down anyway, why not plan to support the businesses instead of hoping that things are going to be fine? We’re going to have a reckoning at some point.”
Ontario was supposed to use the summer to bolster its epidemic response, and while the premier and the health minister keep saying they’re ready, that’s clearly not the case. But even if they’re already too late, they and we still have a chance to change the course. Maybe the province will actually make the right interventions, and have the stomach for the fight.
But at the most local level, it’s back to basics: cut down your social circles, wash your hands, and keep your distance, because the water’s rough again. The province of Ontario has waited too long already. The rest of us shouldn’t make the same mistake.