As some areas of the province prepare to move to <a href="https://www.qpbriefing.com/2020/07/13/government-releases-stage-three-outline-but-10-regions-stay-in-stage-two/" target="_blank" rel="noopener noreferrer">stage three of reopening</a> — meaning indoor dining at bars and restaurants and increased limits on social gatherings — epidemiologists are cautioning that the next few weeks will be critical to the reopening of schools in September. One questioned the government's decision to allow indoor areas of bars to reopen, raising concerns about the increased risk of transmission and saying it's "not a smart step."
Premier Doug Ford announced that regions falling under 24 public health units would be moving to stage three on Friday, with 10 others like Toronto, Peel, York and Windsor-Essex remaining in stage two. As regions move into stage three, group sizes for indoor and outdoor gatherings can increase from 10 to 50 and 100, respectively. The third stage of the government's "recovery phase" will also allow for the reopening of gyms, movie theatres, playgrounds and dine-in options at bars and restaurants. Buffets along with patrons singing and dancing at bars and restaurants will not be permitted, but government guidelines outline the need for physical distancing of two metres between tables or some sort of divider like plexiglass.
"I do not think bars should be opening inside, full stop," said epidemiologist Colin Furness, who is also an assistant professor with the University of Toronto's Faculty of Information. "I want us to open schools in September and I don’t think it’s compatible to open bars now and still expect to be able to do that in the fall, so I’m very very much against that."
The problem with bars, he said, is "a few drinks and the social distancing disappears, this is why people go to bars, it’s not to have social distance, it’s to have less of it, and that to me is extremely concerning."
Furness said he knows his view isn't "good news" for many, and that he still feels continuing to use patios, especially since it's summer, would be much safer.
He pointed to the United States, which is seeing a surge in cases and several states reporting thousands of new cases daily.
"We’ve seen it in a lot of states in the U.S. where two weeks after bars open cases soared," Furness said. "We’re not the U.S. so I’m not trying to say that as soon as we open exactly the same thing is going to happen, but we really can see that most of our new cases are among young people, (in their) twenties, and that’s who goes to bars, so it seems like we’re taking the most at-risk population right now and creating yet another space where a lot of transmission could happen."
The province's latest COVID-19 numbers show that the 20-39 age group accounts for the second-highest number of overall cases in the province (10,923 cases) and the highest number of new cases over the past few days (51 and 54 in the latest two reports).
"COVID is no longer so unpredictable, we can see what it’s doing, we can see where it’s going and we ought to be able to take smart steps around that," Furness said. "Opening bars is not a smart step given who tends to go to bars, who’s getting COVID right now and the kinds of behaviours that we see in bars."
He said any time the province opens something up, there will be increased physical contact, risk and case numbers, but that "we can't have it all."
"We’re going to have to prioritize, and I would prioritize schools over bars," he said. "The reason why that doesn’t seem like it’s a choice right now is that schools don’t open till September, but ... that’s when we’re approaching the risk of a second wave so everything we do to increase risk by increasing physical contact between now and September jeopardizes school reopening."
Ashleigh Tuite, an epidemiologist and assistant professor at the University of Toronto's Dalla Lana School of Public Health, said that as more businesses open up it will be important to monitor community transmission, hospital capacity and any change to the downward trend of new cases, and be willing to backtrack if needed.
"There’s a lot of desire to make sure that schools are able to reopen in the fall, so we really need the coming couple months to continue with decreased disease transmission," Tuite said. "Everything is connected right now; if we have a lot of transmission happening in our communities, it’s going to be hard to have a safe return to school in the fall."
Meanwhile, NDP Leader Andrea Horwath took aim at Ontario's plan to move forward with opening bars and restaurants while simultaneously not having a probable plan to have school open five days a week for all students in the fall, calling it a "wait-and-see" approach to see where the coronavirus is at 10 weeks from now.
She called on the PCs to be more proactive in their approach.
"It's their job to actually make it safe," she said of the government's responsibility for schools, saying that libraries and municipal facilities should be used as classrooms and that more teachers and custodial staff should be hired.
Furness, who also voiced some concern over the increased social gathering limits, said he's a little worried about indoor dining in restaurants and that the risk would depend on things like ventilation or the population visiting the venue. An expensive restaurant that isn't filled with children and young people would be less risky than a Chuck E. Cheese or a bar and grill, he said, although he stressed the importance of proper ventilation.
"If the premises are not really well-ventilated and restaurant operators … they don’t necessarily have much control over the premises that they rent, that’s a potential problem," he said. "There’s ample opportunity for unsafe situations within those guidelines and that’s what’s concerning to me."
While Furness didn't say indoor dining at restaurants shouldn't be allowed, the epidemiologist added that he's "not going to a restaurant any time soon, not at all."
Tuite said one of the biggest risks with bars or restaurants is that "you can’t eat or drink with a mask on, so you’re removing that one layer of protection."
"If you’re in a situation where you’re not able to keep distanced, then the risk increases in terms of disease spread," said Tuite, adding that bars, for example, will likely have to change how they serve people like not having people go up to a bar to order a drink.
In lead-up to the afternoon announcement, Dr. David Fisman, an epidemiology professor at the Dalla Lana School of Public Health who has been critical of some aspects of the government's <a href="https://www.qpbriefing.com/2020/04/08/premier-declares-ontarios-low-testing-numbers-absolutely-unacceptable/" target="_blank" rel="noopener noreferrer">response</a> to the COVID-19 crisis, took to social media to highlight a J.P. Morgan study suggesting a link between restaurant spending and COVID-19 cases in the United States.
<blockquote class="twitter-tweet" data-width="500" data-dnt="true">
<a href="https://twitter.com/hashtag/DeepSigh?src=hash&amp;ref_src=twsrc%5Etfw">#DeepSigh</a> <a href="https://t.co/PniTPLFUYD">pic.twitter.com/PniTPLFUYD</a>
&mdash; David Fisman (@DFisman) <a href="https://twitter.com/DFisman/status/1282678923059507200?ref_src=twsrc%5Etfw">July 13, 2020</a></blockquote>
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The study found that restaurant spending was the "<a href="https://www.sfgate.com/food/article/Higher-restaurant-spending-could-be-linked-to-15369923.php" target="_blank" rel="noopener noreferrer">strongest predictor</a>" of a rise in COVID-19 cases over the following few weeks, with Fisman uttering a virtual "DeepSigh" online.
He has previously voiced his concern over the opening of bars with the hashtag "#SchoolsNotBars." There's been a focus on bars in recent days, particularly in Montreal where at least five bars have reported cases. Public health officials are <a href="https://montrealgazette.com/news/local-news/montreal-bar-patrons-workers-line-up-to-get-tested-for-covid-19" target="_blank" rel="noopener noreferrer">now suggesting</a> that anyone who has visited such an establishment since July 1 be tested.
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<a href="https://twitter.com/hashtag/SchoolsNotBars?src=hash&amp;ref_src=twsrc%5Etfw">#SchoolsNotBars</a>
Priorities, folks. <a href="https://t.co/EHoK0Uc0Rn">https://t.co/EHoK0Uc0Rn</a>
&mdash; David Fisman (@DFisman) <a href="https://twitter.com/DFisman/status/1282071080677646337?ref_src=twsrc%5Etfw">July 11, 2020</a></blockquote>
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A <a href="https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article#comment" target="_blank" rel="noopener noreferrer">study</a> out of Guangzhou, China examined a COVID-19 outbreak at an air-conditioned restaurant where members of three families that were seated about one metre apart became infected with the virus. While 10 people became ill with the coronavirus, another 73 customers sitting on the same floor did not.
"To prevent spread of COVID-19 in restaurants, we recommend strengthening temperature-monitoring surveillance, increasing the distance between tables, and improving ventilation," the authors wrote.
There were limitations to the study, with <a href="https://www.publichealthontario.ca/-/media/documents/ncov/research/research-covid-19-outbreak-air-conditioning-restaurant-guangzhou.pdf?la=en" target="_blank" rel="noopener noreferrer">Public Health Ontario</a> stating in a review that one weakness was the authors didn't "conduct any aerodynamic testing to support their hypothesis."
Asked about why the province felt it was safe to reopen bars, Premier Ford said he was taking the advice of the province's COVID-19 command table and Chief Medical Officer of Health David Williams.
"We're going to contain the size [and] the amount of people within the bars and social distancing, they won't be up there dancing and...singing away, but they can go in there and have a drink at the bar on the patio, and we have to eventually open these restaurants up and get people back on their on their feet," he said.
Meanwhile, both Furness and Tuite lauded the government's decision to allow playgrounds to reopen in stage three, with Furness saying he would suggest children have access to them even in stage two.
Tuite said if parents are carrying hand sanitizer and trying to make sure their children touch their faces as little as possible, the risk on playgrounds is "probably quite low."
As part of the stage three reopening announcement, Education Minister Stephen Lecce also said that as of July 27, child care centres would be allowed to increase their cohorts from 10 to 15 children.
The government touted this change as one that would allow "parents to return to work, and bring the child care sector to approximately 90 per cent of its operating capacity before the COVID-19 outbreak."
Carolyn Ferns, policy coordinator for the Ontario Coalition for Better Child Care, noted that the province would only reach that capacity if "every centre that they’re expecting to have reopened, reopened, and we don’t really know if that’s the case."
Lecce said during the press conference that the government has "confidence we will reach that capacity over time."
Ferns said that as her group recommended in a report on the reopening of child care centres, she would be in favour of "keeping the cohorts small, but repurposing additional public space so you could serve a higher number of children."
This would "allow those children to really interact and have a child care program that runs very much the way as it would normally," she said. "As important as child care is for the economy, it’s also important socially and as part of education."
-With files from David Hains

Reopening indoor dining in bars ‘jeopardizes school reopening’ in September, epidemiologist says

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