‘This is Ontario’s lose-lose approach to the pandemic’
Ontario is being steered into an iceberg, while being told this is the best course. The province keeps defending its mangling of expert advice to actually control COVID-19. The province keeps pretending its framework that eases restrictions might actually slow the virus down.
And despite the bombshell from the Star’s Jennifer Yang and Kate Allen, showing the province quadrupled the thresholds for meaningful restrictions recommended by one of Public Health Ontario’s top scientists, the provincial government keeps pretending this is a scientific decision. On a day where the province’s modelling showed a COVID-19 disaster in the making, we know we need to change course.
And still, Ontario thinks that magically, we won’t sink.
“This is Ontario’s lose-lose approach to the pandemic,” says Dr. David Fisman, epidemiologist at the Dalla Lana School of Public Health at the University of Toronto.
It is clearer than it has ever been that the province is lying to us, or itself.
On Nov. 2, Health Minister Christine Elliott said, in prepared remarks: “Our COVID-19 response framework was developed in consultation w of health, the public health measures table, local medical officers of health and other health experts.” On Thursday, Elliott told Colin d’Mello of CTV News that the thresholds “were provided to us as recommendations to us by the public health measures table, by (chief medical officer of health) Dr. (David) Williams, and by the local medical officers of health.” She said the numbers were submitted to the government, and were not changed.
But as reported by the Star, the public health measures able did not see a final version of the plan with the higher thresholds, and never offered an endorsement. Elliott later said the province’s modelling table was consulted, but like the province’s independent science table, that was not the case.
And as for consulting local medical officers of health, that is a sham, too. On Oct. 30, the Friday before the announcement, according to multiple sources familiar with the negotiations, the province engaged with the medical officers of health in the four provincial hot spots of Toronto, Peel, Ottawa and York: Dr. Eileen de w Villa, Dr. Lawrence Loh, Dr. V Kurji, respectively. The frameVVKw MOHs were asked to focus on which restrictions should be in w
But the document presented showed significantly lower thresholds. As Yang and Allen reported, in September Public Health Ontario had recommended rates of 25 cases per 100,000 per week, and a 2.5 per cent test positivity to trigger the red “control” stage, or most severe stage before lockdown.
The document shown to the medical officers of health showed thresholds of under 10 per 100,000 per week for the green “prevent” level; 10-25 for the yellow “protect” level; 25-40 for the orange “restrict” level; and 40 and above for red, “control.” They were told the thresholds were still under review.
Still, the four MOHs believed their regions would land in red, and made recommendations to the province to actually expand the restrictions in the red “control” zone, including closing indoor dining. When the framework was sent to all 34 MOHs an hour before a briefing conference call with chief medical officer of health Williams on Tuesday, Nov. 3 — after various municipalities had already had the plan sent to them by the government — the thresholds were much, much higher.
der 10 for green stayed the same. Yellow was now between 10 and 40. Orange was between 40 and 99.9, with test positivity expanded to 2.5 per cent to 9.9 per cent.
And red had garishly high thresholds: 100 cases per 100,000 per week, a number only two jurisdictions in Ontario had reached to that point of the pandemic, and a 10 per cent positivity rate. Those thresholds indicate a virus running wild. All four regions were suddenly in the orange “restrict” category, which would still allow up to 50 people in indoor dining, gyms, meeting spaces, casinos, bingo halls, cinemas and performing arts spaces, along with indoor dining in mall food courts. And the suggestions from the four public health units were ignored.
So yes, the numbers sure as hell changed, and the question now is who will admit to changing them. The muchmentioned, health command table — which as the Star has reported has no decisionmaking power, like all the tables, and which has since changed its name to the health
dination table — wasn’t meaningfully consulted.
Which either makes this a political decision, or it leaves Williams, who is both so behind the times and so far in over his head that he should walk around in a brass diving helmet. Thursday, Premier Doug Ford said, “Dr. Williams came to us with a framework. Cabinet approved the framework.”
Which means Dr. David Williams should resign today, right now. That, or he should be fired. No reputable doctor would put their name on this.
“Why is Dr. Williams’s strategy to wait until the patient is dead before initiating treatment?” said Dr. Michael Warner, the head of critical care at Michael Garron Hospital in East York.
This plan removed restrictions, and we know what’s coming. On Oct. 29, the province’s science table presented modelling showing Ontario was on pace to stay below the w cases a day, but that was within the realm of the projections. A set of pie charts representing under 15 per cent of total cases — identified outbreaks — showed low numbers in restaurants and bars, and this was taken as gospel, despite what we know about how the virus spreads, and despite data from every other jurisdiction studied. The government seems to have changed its strategy based on that misunderstanding of the data.
The modelling now shows Ontario is on track to being a horror show. At five per cent growth — described as somewhere between current and slightly optimistic — the province will hit 6,500 cases per day by mid-December if no measures are implemented, which would exceed the trajectories of European countries that are in strict lockdowns. In every scenario the province is now on pace to exceed the 150-ICUbed threshold that results in surgery cancellations; it could also hit the 400-bed threshold, a down. Long-term-care cases are accelerating, with deaths here and to follow.
Asked if Ontario needed to impose restrictions, Dr. Steini Brown, the head of the province’s independent science table and the dean of the Dalla Lana School for Public Health at the University of Toronto, said grimly, “If the goal is to reduce
ses and to reduce the strain on our health system, yes.”
And Williams stood next to him chattering about possible herd immunity, about waiting to see if removing restrictions might help the numbers, about whatever fog of war he finds himself lost in, swirling all around.
So now medical officers of health all around the province are preparing to intervene long before the province’s thresholds arrive, despite having weaker powers, because an emergency is coming and the province can’t be arsed.
“They might just tolerate deaths in long-term care as the cost of doing business, and that’s chilling,” says Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital. “This is senicide.”
He pointed out the province has failed to decrowd homes, didn’t commit to hiring additional staff until September, four months after Quebec did, has not implemented the huband-spoke infection control model that was recommended in June. And he points out the simplest part of protecting long-term-care residents.
“It’s so simple,” Dr. Stall says. “Control on.” community transmis“s
And the government is still defending its plan, even as its actual medical credentials winnow to nearly nothing. Peel should be in lockdown now. Toronto isn’t far behind. Without restrictions, more will follow.
“This is theology-based, for lack of a better word, and the theology is that balance means you can’t close businesses for any substantial period of time to control the virus,” says Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto, and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network. “You and I know that’s a failing approach. And I do appreciate the premier’s dilemmas. I understand it.
“But it’s hard to imagine that Dr. Williams both understands the issues, and is honestly saying keep things as they are. I just find those two things impossible to reconcile. He either doesn’t believe the advice he’s giving, or he doesn’t understand the situation that we’re in.
“The system is designed for us to have a bad outcome, and we will have a bad outcome. Hospitals will be overwhelmed, which we saw in Peel already and we’re going to see in other jurisdictions in the next while. And when it happens, it’s not totally predictable, we don’t really know when that happens, but it just happens like gangbusters. And when that happens it’s going to be really unfortunate, and many of my colleagues and I are resigned to the fact that we’re going to be working full bore over Christmas, because that’s when it’s going to be in full force.
“And then we’ll go into lockdowns, European-style lockdowns. And then we’ll be talking once again about a balanced approach after the fact.”
Who will ever take public health advice from Dr. David Williams again? Who will take Christine Elliott’s advice seriously as minister of health? They defended this plan. They endorsed it. And we have been lied to. At least the premier can say he might not comprehend it.
There should be resignations, today. This government decided to hope hospitals wouldn’t be overrun, to embrace deaths in long-term care, to let the virus run wild over credible scientific advice, and lied about it. We should be guided by science and public health so we can have a healthy economy. It’s the only way any country has beaten this thing.
But that’s apparently too hard, so we’re doing this instead.