Ontario doesn't have the public health foundation necessary to fully reopen the economy and embrace the "new normal" just yet, according to the province's medical association.
The Ontario Medical Association (OMA) released a report on five public health "pillars" it says must be in place for the province to fully reopen, and must remain in place until a vaccine or other treatment is available.
The province is planning to progress to stage one of its reopening on Tuesday, which includes allowing retail stores with street entrances to welcome customers. The province's plan is to gradually reopen more, as long as the number of new COVID-19 cases remains manageable.
The OMA report identifies some areas where the province's readiness falls short for a full-scale reopening of the economy.
"One of the things the province is doing really well is moving slowly," said OMA President Dr. Samantha Hill in an interview with QP Briefing. "That's going to be exceptionally important, that we go slowly, and carefully, and safely as we look to get back to what we think of as our 'new normal.'"
One of OMA's chief concerns is contact tracing, the process by which public health workers contact people with COVID-19 and ask them for information about everyone they were in contact with and everywhere they went when they may have been contagious, so that those people can be tested and told to self-isolate. It must be done quickly to be effective and the province's goal is to reach 90 per cent of contacts of COVID-19 cases within a day, but that isn't happening yet, the report says.
In general, contact tracing allows more than just essential workers to work, by identifying those who may be at risk through contact with someone who has COVID-19 and isolating them, the report says.
"Ontario needs to bolster its contact tracing capacity to be able to meet its targets for safe reopening," the report says.
"In addition, reopening should not begin until case levels are such that thorough contact tracing is feasible," it continues. "Currently, the number of cases is such that Ontario does not have a sufficient contact tracing workforce to meet effective tracing targets. There are ways to increase that capacity, but current quarantine measures should continue until Ontario has sufficient tracing capacity."
The province should bolster its contact-tracing workforce with technology, such as a Bluetooth-enabled app, like the one in use in Alberta, as long as privacy is protected, the report says.
Testing capacity goes hand-in-hand with contact tracing, because testing is required to identify positive cases, the report notes.
"Sufficient testing capacity for all COVID-19 cases and vulnerable individuals must be in place before reopening can begin," the report says. It also recommends "proactive" testing of essential workers and their families, as well as members of vulnerable populations, when they are asymptomatic. The province has taken steps in that direction, starting with residents and workers in long-term care.
The report recommends increasing testing and embracing new testing technologies, such as rapid point-of-case tests and serologic testing, which determines if someone has had COVID-19 and developed antibodies for it — another crucial step, said Hill.
Another concern is the supply chain for personal protective equipment, she said, adding that Ontario community clinics have reported to the OMA that they're in short supply of necessary items including masks and gowns, but either can't find it on the market or are being forced to pay unbelievable markups.
According to <a href="https://content.oma.org/wp-content/uploads/Reopening-Ontario-5-Public-Health-Pillars.pdf" target="_blank" rel="noopener noreferrer">"Reopening Ontario to a 'New Normal,'"</a> the five pillars are as follows:
<ul>
<li>Continuing personal protective measures, including wearing masks, physical distancing, influenza vaccination and hygiene practices</li>
<li>Continuing necessary testing, with investment in and uptake of innovative testing solutions, as well as serology testing and immunity research</li>
<li>Capacity to trace all case contacts and to enforce and support contact isolation</li>
<li>Protection of all populations and targeted approaches to protecting children and vulnerable populations</li>
<li>Balancing public trust in and public compliance with the other public health pillars to safely reopen Ontario</li>
</ul>
The report also contains advice for the safer operation of businesses and public transit. It also advocates for non-medical mask-wearing in public places, and recommends the province adopt a "social bubbles" strategy that will allow families to have some social support to combat isolation, while limiting the risk of wider transmission.
Lastly, it stresses the importance of clear communication of public health information, saying it "should be simple, timely, effective, evidence-based and transparent to build public trust."
Hill said that communication is incredibly important because it will allow Ontarians to understand how they can go about their lives in a way that will allow the province to reach the "new normal" — and not to live in the same way as before the pandemic — but in a way that is less isolated and incorporates much of what the public has learned so far.

Ontario not yet ready for the ‘new normal,’ medical association says

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