Even the best-case scenarios are not good.

The only question now is how catastrophic it becomes with a projected surge in cases

The catastrophe is here. It’s understandable if you can’t imagine how bad this is, or how bad it will get, because even people in health care can’t believe it. Friday the Ontario government is expected to introduce stricter public health restrictions for the third time in three weeks, because Ontario’s panicked, pleading attempts to negotiate with a virus were always doomed. The only question now is how catastrophic it becomes.

“There are no good options anymore,” said a Science Table source, who declined to share the specific COVID-19 projections on hospitalization, cases, and death Friday. “We’re past that point.”

Usually the province’s independent volunteer Science Table delivers a Wednesday briefing to cabinet, before presenting data to the media and public on a Thursday. This week, following the cabinet briefing, the Thursday science table briefing was moved to Friday, with cabinet suddenly debating further restrictions.

The projections are said to be between 12,000 and 18,000 cases per day by the end of May if nothing is done, and the nightmare of 1,800 patients in the ICU. The best-case scenario is now believed to be 1,000 in the ICU, more than double the second-wave high.

Even that would probably require an immediate European-style lockdown, which Ontario has never attempted: a ruthless delineation of what is and is not essential work; paid sick days, which is the ideological Rubicon this government will not cross; travel restrictions between provinces, and within the province. In France and other jurisdictions where the variant overwhelmed them, people were allowed to travel only within 10 km of their homes, and there was a 7 p.m. curfew.

None of it is pretty; aside from paid sick days and closing businesses, none of it could be easy. With every compromise, the catastrophe will widen further.

“Because this keeps seeding from high-risk regions to the low-risk regions, the low-risk regions can never really get their counts down,” said Dr. Kieran Moore, the medical officer of health for Kingston, Frontenac, Lennox and Addington, where patients from Scarborough have been airlifted for weeks. “Restricting travel across Ontario is one means that we can allow all areas to try to recover, and get their counts down so we can get back our economy. I don’t know when that can happen, given that the rate of illness is so high in our high-risk regions right now.

“We’re in big trouble. I look at the Ontario data, and the immunization data, five times a day. We can’t immunize our way out of this: we have to public health measures our way out of it.”

The variables now are how far this government goes to limit mobility, and how a populace exhausted by months of restrictions reacts. The stay-athome order instituted last week may have had an effect, but the traffic didn’t slow: mobility often equals contacts, and contacts spread the virus. The variants are ravaging this province; the seven-day average is a record 4,208 cases per day, and they are incredible undercounts, because the positivity rate on tests is climbing the walls, too.

The government has let this spiral so far out of control. They were warned, but they reopened Ontario to variants anyway.

So people are gasping, and hungry for air, and dying, and more every day: often younger, essential workers, racialized, vulnerable. The hospital system is already crumbling in places we can’t see. There are COVID patients who would usually be in the ICU, but are being cared for in the wards — one hospital executive in the GTA estimates they number in the hundreds.

“In January, and in the wave that hit over the New Year, we began to start administering high-flow oxygen by nasal prongs,” said the doctor, who requested anonymity. “And we can go up to a certain rate, 6-8 litres per minute, it gets pretty uncomfortable. And then you go on a face mask, and progressively higher amounts of oxygen. And previously, once we maxed out the oxygen we could deliver by face mask, we’d get the ICU involved, because not only did they need something we couldn’t deliver on the wards, it was a barometer of people who are getting sicker.”

Now they use a technique called high-flow nasal cannula, which delivers up to 90 per cent oxygen — the stuff you and I breathe is 21 per cent — and then put a face mask over that, so that they cram as much oxygen into a human as possible. As the doctor said, “We’ll see more and more people pushing the limits of what they can do in an emergency department or on a ward, just because there’s no place to put these people.”

“Pre-pandemic, all the time, doctors made decisions about which patients go to critical care units, or which patients go on life support, all the time,” said one GTA hospital source with extensive knowledge of the system. “It’s a fuzzy line, and it varies from institution to institution. I’m 100 per cent sure that fuzzy line is moving. I think it is fair to say that families of people who would have previously been offered life support, are not being offered life support.”

That kind of situation is unfolding with only 653 patients in the expanded ICUs. If you want to keep the hospitals from truly cratering, everything that isn’t truly essential — food, medicine, the backbones of a functioning society — would have to close. That the government announced increased enforcement at construction sites Thursday tells you they won’t go that far.

No, it’s mitigation now, and choices that will weigh disproportionately on the most vulnerable no matter what we do. This government has failed Ontario in the most unthinkable, unforgivable way. All those people gasping for air, all

“We’re in big trouble ... We can’t immunize our way out of this.”

DR. KIERAN MOORE MEDICAL OFFICER OF HEALTH FOR KINGSTON, FRONTENAC, LENNOX AND ADDINGTON

those doctors and nurses trying not to crumble, all the businesses shuttered and maybe gone while others were allowed to carry on: they belong to this government, on a butcher’s bill.

And now this. At every phase, they didn’t go far enough; at every stage, they waited. Bargaining with a virus is a hell of a way to lose. So now Ontario has reached the ugliest stage, after everything that could have been different. What do you do when it’s too late?