By David Hains and Jessica Smith Cross
Ontario is facing a disastrous health-care-system scenario the likes of which the province has never seen and the government is responding with additional public health measures in an effort to curb the impact of the crisis.
The most recent data modelling strongly warned that intensive care occupancy and COVID-19 cases will continue to spiral out of control even in the best-case scenarios.
In response, Premier Doug Ford announced a suite of new public health measures that go further than before. They include:
- The stay-at-home order, which was originally set to expire on May 6, will be extended for another two weeks.
- People will be restricted in outdoor activities to members of their own household. People who live alone may join one other household.
- The land borders between Ontario and Manitoba and Quebec will see checkpoints established and travel will be limited to essential purposes like work, medical care, and the transportation of goods.
- Non-essential construction will be shut down, although the government could not define what non-essential meant one hour after the announcement was made.
- Playgrounds, tennis, basketball, golf and soccer games and camping among other recreational activities will be shut down.
- Police and bylaw officers will be given the legal authority to stop and question Ontarians about their travel, and issue fines for non-compliance.
- Inspectors will visit workplaces like law offices and accounting firms to ensure they are following the guidelines.
- Big box retail will be capped at 25 per cent.
- Places of worship will be capped at 10 people indoors. Weddings and funerals will be capped at 10 people indoors or outdoors.
The premier, who chose not to implement a stay-at-home order when it was recommended by the science table in late March, and who loosened health restrictions despite advice on Feb. 11 that disaster loomed, said that the time to act was now.
"I've never shied away from tough decisions," he said, using a sombre tone. "My friends, we're losing the battle between variants and vaccines," he said, although many health experts warned that Ontario would be unable to vaccinate itself out of the third wave crisis.
The premier also denied that acting on these types of harsher health measures earlier would have stopped some of the significant damage that Ontario will see in the coming weeks. "That wouldn't have stopped it," he said. He claimed that the government acted "decisively" in the past couple of weeks and blamed people for gathering in parks as though it's "business as usual."
He laid out what the province's strategy involves. "It comes down to three things: limiting mobility, enforcing the rules and getting vaccines into arms," he added, explaining that it was necessary to extend the stay-at-home order by two weeks.
He also urged Ontarians to do their best to stay at home and follow all public health protocols.
Meanwhile, Ontario NDP Leader Andrea Horwath slammed the measures as too weak to save lives.
"The premier is, once again, making decisions based on politics as opposed to the expert advice and it shouldn't be that way," she said. "We are in an absolute crisis."
She also raised concerns about what the stronger law enforcement power will mean for essential workers — who are more likely to be stopped as they have to leave their homes — and for racialized people, who have been disproportionately targetted by police.
"This isn't to say that I'm blaming the police, but what I want to say to people in Ontario is we have to be very careful about these types of measures," she said. "I mean, we know that there is disproportionate policing in some instances in some communities with some racialized folks and these are exactly the same people that we're relying on, that are our essential workers on the front lines."
Ontario will look different for the next four weeks, with the province trying to see the same kind of impact on mobility that was originally seen during the first wave. That means that even many outdoor outlets — where transmission is much less likely — will be closed, like playgrounds, or camping on Crown land.
The premier also tried to defer responsibility for the situation to the prime minister for an insufficient vaccine supply, pointing to data modelling that shows case numbers would be lower if more people were vaccinated.
"Unfortunately, we know in the short term we are not expecting to get the supply we require to do so," he said in a statement before his announcement in an attempt to get ahead of criticism.
However, he misinterpreted a slide from the modelling presentation at his press briefing, suggesting that a faster vaccination campaign would have a far greater impact than the chart showed.
"We see this modelling as a reminder of just how important vaccines are in this fight," he said. "If there is anything the federal government can do to help us get more supply sooner, now is the time to do it."
Based on new federal government forecasts, Ontario could hypothetically average 200,000 shots a day until the end of June, with that ramping up from 100,000 a day now as more supply arrives quicker in May. There is not a scenario where it increases to 300,000 a day, a number that was included in modelling scenarios.
The premier also criticized porous border controls for allowing the variants of concern into Ontario, another shot at Ottawa.
The measures, which were the subject of prolonged cabinet debate that extended through Thursday well into Friday, fell short of what the Ontario COVID-19 Science Advisory Table recommended hours earlier as it released the latest data modelling.
The science table had recommended that the province's stay-at-home order, which was implemented on April 8 and set to last at least 28 days, should be extended by another two weeks. "A six-week stay-at-home order with a vaccination rate of at least 100,000 doses per day is the only way to flatten the curve," the modelling presentation states.
Dr. Adalsteinn (Steini) Brown, the co-chair of Ontario's science table, also recommended that only essential workplaces should be open right now and that the government should consider limits on mobility and borders.
The science table also recommended Ontario focus vaccinations on those at highest risk, implement a high degree of workplace enforcement, and begin offering "easy-to-access support to stay at home when sick."
The latter speaks to the controversy over paid sick days, a matter on which the Progressive Conservative government has refused to budge. Today's measures did not contain any paid sick leave policy and the announcement did not contain any support measures for essential workers.
"We are now entering the hardest stage," Brown acknowledged, speaking to an unprecedented crisis that is accompanied by public fatigue with pandemic vigilance. "We may just be too tired to notice."
He added, in a throwback to first wave messaging when Ontarians were more vigilant about remaining at home, "the goal here is to flatten the curve as much as possible."
The numbers seem to urge both the government and the public to appreciate the gravity of the crisis.
The modelling projects Ontario can still expect to see over 6,000 new daily COVID-19 cases by the end of the month. Whether or not the province adds more effective public health measures would determine what happens from there. A scenario where the province introduces measures as effective at reducing transmission as occurred at the beginning of the first wave, cases would fall from there but only continue to fall if the measures are extended for an additional two weeks. Merely maintaining the public health measures already in place, including the stay-at-home order, would see cases rise to about 9,000 cases in late May, and either rise or plateau, depending on if the measures were extended when the stay-at-home order expires.
On Friday, Ontario set another new record today with 4,812 new cases. Ontario also had a test positivity rate of 8.2 per cent, suggesting that there are significantly more cases out in the community.
In the short-term, Brown said that Ontarians should expect that cases will keep rising over the next two weeks regardless of the actions taken.
COVID-19-related patients in ICU beds would also reach just under 2,000 by mid-May, and even with stronger health measures implemented, would reach around 1,500 by May 14. That would more than double the 701 currently in ICUs, which represents a record. In late 2020, the province said that once COVID-19 patients in ICUs exceed 350, it becomes "impossible" to handle.
The presentation also noted that ICU stress is currently compromising care for all patients in the health system. In the past two weeks, Ontario has seen 51 per cent growth in COVID-19 ICU patients, and 67 per cent in COVID-19 hospitalizations.
But beyond these dire numbers, it could be even worse. The presentation warned that with weaker than current public health measures and the current rate of vaccination, Ontario could have seen over 30,000 new daily cases by the end of May. Even if the province managed to pull off 300,000 vaccines a day — a feat that would be impossible given the supply of vaccines thus far — with weak public health measures Ontario would still see about 20,000 new cases per day by the end of May.
More action is needed immediately lest the third wave totals continue for months, officials warned.
"Without stronger system-level measures and immediate support for essential workers and high-risk communities, high case rates will persist through the summer," the slide deck from the science table stated.
Twenty-eight of Ontario's 34 public health units are seeing increases in cases compared to March 29, and some of them quite rapidly. Peel Region has a sky-high test positivity rate of 15 per cent — almost twice the provincial average, and seven times the threshold of what constitutes a concerning level, per health guidelines.
The increase in cases is not because more testing is being done, the presentation noted, as testing levels remain flat. Despite its struggles, the Windsor-Essex region remains among the lowest for testing per 100,000 people, according to provincial data that shows it at less than half of the provincial average.
And while the variants of concern continue to rise alarmingly, even the original strain is seeing a reproductive value above one, meaning that despite public health measures and its lower transmissibility, it too is increasing.
These dire scenarios had been predicted by health experts in February when Brown agreed with a journalist's premise that the data modelling at the time predicted "disaster." However, the government chose to loosen public health restrictions and then loosen them further in late March despite climbing numbers and widespread warnings from health experts.
This month, the government did not immediately choose to issue a stay-at-home order despite being advised to by the science table, instead opting for a "shutdown" that was similar to existing health measures in the province's worst hot spots, which were seeing rising numbers.
While the province has made some progress on vaccinations, the modelling states that the province cannot rely on vaccinations alone to get it out of the third wave crisis.
Federal support offered
Meanwhile, Prime Minister Justin Trudeau offered Ontario support from the Red Cross in vaccine deployment but was rebuffed.
"There's no doubt that Canada's largest city is struggling under the weight of this third wave. So we're going to do whatever it takes to help on vaccination," said Trudeau on Friday. "In particular, Ontario has reached out for more support. I can tell you today that we are standing by to deploy the Canadian Red Cross to help with their mobile vaccination teams."
But in a statement, the premier's office turned down that offer: “While we appreciate the prime minister’s offer, unless it is matched with an increase in supply, we do not need the Red Cross at this time for the administration of vaccines in Ontario. We do not have a capacity issue, we have a supply issue.”
The federal government did announce increased supply: an additional 8 million Pfizer doses by the end of July. Ontario's share, based on the current per-capita allocation, would be more than 3 million doses, with half coming in May and the rest split between June and July. It comes along with the news that Canada will see half of its next Moderna shipment, initially expected later this month, further delayed and halved, resulting in 224,200 fewer doses for Ontario this month, and the possibility of further delays.
Trudeau also confirmed reports the province has sent a draft request for more than 600 health-care workers but declined to say whether the country has that many people to send.
"We look forward to delivering any and all supports that they need," said Trudeau. "Those conversations are extremely live right now and ongoing. I know there's also been discussions about health care resources from other provinces, turning towards Ontario, these are all the things that we're working very, very hard on right now, to respond to the extremely difficult situation in Ontario."
However, in a statement to QP Briefing, the province denied that either the solicitor general or minister of health had made any such requests to the federal government, or to other provinces. However, CTV reports the request for assistance to Alberta was sent by a senior civil servant, copying the premier and health minister.
As for the federal request, the distinction may be in the details if a draft request precedes a formal one, as was the case when the province requested military assistance for its long-term care homes in the first wave.
Trudeau said the federal government has already deployed mobile health units, or field hospitals, in Ontario, and shipped out more health care equipment and drugs, approved a request to have the Canadian Red Cross deployed in up to 27 long-term care homes, supported safe isolation sites, and deployed 300 contacts tracers, and provided laboratory support.