After nearly three months of limiting interactions to individual households, Ontarians can officially start hugging family and friends they don't live with through a "social circle."
"A social circle is made of families and friends who you can interact with without the need for physical distancing," said Health Minister Christine Elliott on Friday afternoon.
Chief Medical Officer of Health Dr. David Williams updated public health advice on Friday to allow people to establish a "social circle" — similar to the commonly used term of a "social bubble" — of up to 10 people who they can interact with freely without maintaining a distance of two metres. The recommendation to form social circles went into effect immediately, Elliott said.
"Social circles will allow family and friends to reunite safely while reducing the risk of exposure and spread," said Premier Doug Ford. "This means finally hugging a grandparent or sharing a meal with your parents or your closest friends."
Elliott said social circles would help people struggling with isolation and would also provide support for people who need it, such as by providing child-care options.
"Social circles will also enable Ontarians to enjoy close contact by dining together at home, outside or on restaurant patios," she said.
The government outlined five steps that Ontarians can take to set up a social circle.
People should start with their current household, whether that means family or friends, and can add other households to their social circle from there.
Elliott said this could mean adding grandparents and other family members or another family with similarly aged children.
"Be sure to include anyone that would come into regular close contact with the people you live with. This may be another parent to your child(ren) that lives outside the home or a babysitter or caregiver," a government guidance document stated, adding that it's important to include the people in a babysitter's household, for example, as well. "Remember that everyone in a household must be part of the same social circle."
It's also important to get agreement from everyone joining a circle and for people to "be true to your circle," said Elliott, adding that no one should be part of more than one circle.
"If you just start with your own personal situation, and then build it from there, it really isn't difficult, it's mostly common sense when you finally take a look at it," she said.
But the health minister stressed that the rules for social circles are different from the expansion of social gatherings from five to 10 people, which also went into effect Friday across the province — coinciding with the shift of several regions to stage two of reopening.
A social circle is like an enlarged household, explained a ministry official during a background briefing on Friday morning, meaning people should still practice physical distancing with those outside of their "household" or "social circle."
"Social gatherings can be any 10 people from outside your household or circle, but where physical distancing of at least two metres must be maintained," said Elliott, meaning people can enjoy picnics or barbecues with people outside of their circle as long as they keep their distance.
Williams and Elliott have previously said the province was considering the idea of social bubbling, but the challenge was figuring out the appropriate number and how this would work. Both New Brunswick and Newfoundland and Labrador moved to allow tw0-household bubbling at the end of April.
Asked about Ontario's approach, which could technically allow 10 single-person households to join to form a social circle, the ministry official said the number of households is less important than the size of a circle once it’s completed.
The larger the circle, the more opportunities there are for transmission within it, the official said, adding that while there's "no perfect number," 10 people is larger than most households, but isn't "so large that there are many opportunities for transmission."
Williams said people don't have to form social circles and they don't have to include the maximum number of people.
"You don't have to go to 10. You can add as many as you want, you can add them over time, so it isn't instantaneous," he said. "Take some time, it’s common sense, think about it, of how you'd like to do that, because in that time you want to trust the people in your group."
Part of the reasoning for sticking with the same groups is also to help with contact tracing, said Williams, noting that if one person gets COVID-19, it's easy to identify the other people who have been in close contact with that individual.
Ford said it would be difficult to enforce these guidelines with 14.5 million people across the province and that he's relying on people to "follow the protocols."
"We trust you’re going to be doing the right thing," he said.
Asked whether he expected a spike in cases in a couple of weeks given the changes all taking effect Friday, Ford said he hopes not.
"I'm a strong believer if they follow the protocols...at least we can contain it," he said. "God forbid, someone within your group of 10 catches it. You look at the nine other people so we can control the spread, and controlling the spread is absolutely critical. That's what drives the numbers up, if we can't do the contact tracing properly, and finding out who they've contacted to make sure that those folks get tested."
"Let's see what happens, if we come to that bridge we'll cross it, but...I hope we can continue on with the same trend," he continued.
The government said people who are considered to be at "higher risk" of severe illness from the novel coronavirus — those over 70 or with compromised immune systems and/or underlying medical conditions — can be part of a social circle depending on their own circumstances. It's the same for frontline workers like health-care or retail workers, provided that others in the circle are informed of the risks and agree to them.
These individuals should "think carefully about what role they play in a circle," the ministry official said, adding that they might choose not to join a circle, or join a circle but maintain physical distancing with some members.
The official said he didn’t think there was anything that would prevent a family with a child in daycare from joining a social circle since children are among the least likely members of the population to become infected and transmit COVID-19. But, asked about grandparents, he said there would be different factors to balance when deciding whether to bring them in. This could include the health of the grandparents or if the grandparents require support from their family, the latter of which might be more important for some than the risk of exposure to COVID-19.
Ashleigh Tuite, an epidemiologist and assistant professor at the University of Toronto's Dalla Lana School of Public Health, said personally, "if my child was attending daycare, I probably wouldn’t introduce grandparents into the circle."
The important thing, however, is to have open conversations with people you want to invite into your circle, she said.
"I think having that conversation around, 'Our child is going to be attending daycare, there is possibly an enhanced risk that they’re going to bring infection into our circle, are you comfortable with that?'" said Tuite.
"There isn’t a one-size fits all; everyone will have to make that decision for themselves," she said.
Epidemiologist Colin Furness, who is also an assistant professor with U of T's Faculty of Information, said he thinks it would be safest for families to have a grandparent or an extended family member take on the role of child care, if that is an option.
"Obviously there’s a conflict between the concept of bubbling and the concept of aggregating kids together in child-care situations," he said, adding that it breaks the rule that people should only be members of one circle.
But he said it's not as bad as "recreational shopping" because child-care centres are, in a way, their own bubble.
Furness said he thinks the province needs to shift back to curbside pick-up for clothing stores and other non-essential retailers, especially with the social circles announcement.
He said he's witnessed some "deeply unsafe" situations and inconsistencies when it comes to stores putting in place "appropriate precautions."
"Your bubble weakens when a member of your bubble is in a scrum at a 50 per cent off sale where there’s no physical distancing and inconsistent use of masks, so the Achilles' heel in our bubbling...is recreational shopping," he said.
Both epidemiologists welcomed the announcement about allowing social circles, with Furness calling it "overdue."
"I think this is a great step forward, it’s actually my birthday today and this is a fantastic birthday present, this is a big positive thing and I’m feeling quite pleased about it," he said. "My only criticism is that this didn’t happen sooner."
Tuite said she thought the announcement and guidance on social circles was "very clear in terms of what this means and how you do it" compared to some other announcements, such as the one on larger social gatherings, which she noted has resulted in some confusion.
But she acknowledged that while the concept of social circles is "pretty straightforward...as you dig into it and unpack it there’s a lot of nuance there."
It "makes a lot of sense just in terms of what we know in terms of COVID and how it spreads and thinking of how do we allow people to interact with other people and have the support systems that they need in place while also trying to minimize disease spread," she said.
Tuite said she didn't think there was an issue in rolling this out province-wide rather than just in the parts of the province that have entered stage two.
"There’s still probably more infection happening in the parts of the province where we’re still in stage one, but I think we’re at a level where slightly expanding our networks is probably going to be okay," she said. "I think the net benefit is probably going to outweigh any harms."