A third wave is coming. Where is Ontario's plan?

OPINION: New modelling suggests that variant-driven case counts could rise quickly — yet the province is reopening
By John Michael McGrath - Published on Feb 12, 2021
Adalsteinn Brown, dean of the University of Toronto's Public Health Department, answers questions during a news conference at Queen's Park on April 20, 2020. (Frank Gunn/CP)

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During Thursday’s briefing on Ontario’s COVID-19 modelling, I asked a question, inadvertently providing a clip that went viral on Twitter. “I’m a bit confused by this presentation … Am I missing something here — or is this presentation actually predicting a disaster?” The response from U of T’s Adalsteinn Brown: “No, I don’t think you’re missing anything.”

I wasn’t trying to be showy. I actually was — and still am — confused, though, thanks to Brown, I at least know I’m reading the modelling correctly.

It’s your right, as a citizen, to be skeptical of the modelling that’s been presented to the public to justify the policies the Ontario government has imposed on us all to try to navigate this pandemic. If you think it’s all garbage and that the eggheads don’t know what they’re talking about, I’m not going to try to convince you otherwise. But I will say you’re wasting your breath: the important thing to know is not whether the modelling is right or wrong (obviously, it matters in the real world, but I’m talking about politics) — but whether the government says it’s basing its policies on the modelling, as well on as the other scientific advice it has received to date.

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So to even start interrogating Ontario politics in February 2021, we’ve got to take the modelling presented to the public as given, assume it’s true and move on. And the modelling that Brown presented shows that, before the second wave of COVID-19 has even receded in the rearview mirror, the third wave is coming up fast.

The culprit is the well-known “variants of concern,” the mutations of COVID-19 that are more infectious and potentially more dangerous. With the original variant of the coronavirus, it was enough to push the virus’s reproductive number below one — that is, one person infecting, on average, less than one new person. With these more infectious variants, we need to somehow keep the reproductive number below 0.7.

That's easier said than done: we've only briefly approached an Rt of 0.7 on a few occasions before now, though on Friday, epidemiologist David Fisman estimated that Ontario had managed to push it all the way down to 0.6 provincewide and 0.51 outside the GTA. The problem will be sustaining that kind of performance long enough to really hammer down the infection. 

Okay, but vaccines will help, right? No, they won’t, because we can’t get them in sufficient volume in time. We might avoid the horrifying death tolls of the first and second waves in long-term care, now that vaccination there is well underway, but to avoid an implosion in the hospital sector, we’ve got to keep ICU admissions to a manageable level. And we can’t do that if cases surge back into the thousands per day. Something Matt Gurney wrote for the National Post at the beginning of this pandemic is still true:  “Thousands of sick young people can crash a health-care system as effectively as thousands of dying seniors.”

Okay, then we need to rely on public-health measures, right? Well, the good news is that the same measures that work to control the original variant of COVID-19 work on its more aggressive cousins. The current state of the science actually gives us more confidence in that than in the efficacy of our current vaccines when it comes to some of the new variants.

The bad news is that current Ontario policy is to end the stay-at-home order for almost everywhere in the province. Starting next Tuesday, we’ll be reverting to the regional framework we had in the fall and early winter everywhere except Toronto, York, and Peel (those regions will follow the week after). The government, and Chief Medical Officer of Health David Williams, has insisted repeatedly that this isn’t a “reopening” and that people shouldn’t go wild. Obviously, that’s correct. But we’re still talking about a relaxation of public-health measures that have worked, whether you credit the stay-at-home order or the provincewide lockdown that preceded it.

And the government’s decision to move March break into mid-April — whatever the merits of that decision in isolation— add further confusion, since the modelling also shows cases starting to trend back upwards in late March. The modelling doesn’t peer into April itself, but if you believe it is basically right — as the government says it does — then it’s weird to assume that cases will immediately start trending back down. The modelling might be wrong — indeed, as far out as late March, it’s bound to be wrong in some way. But it’s supposed to be forming the basis for the government’s planning and policies, and in some very basic ways the modelling and the announced policies don’t match. It’s a simple enough question: If the third wave is coming, what should Ontario be doing to take that threat seriously?

I don’t think that Ontario necessarily needs to go back into a harsh lockdown and a renewed stay-at-home order (though that might end up being the answer we choose, either by action or omission). There are still, today — now, as you read this — things the government could do that would help push the needle in the other direction, away from explosive infection growth. On the topic of paid sick leave, people have gone from “inquiring” to “calling for” to “demanding” to “pleading.” The Tories can change their minds any time they choose; there’s even an NDP private member’s bill coming up at the legislature for it.

There are other measures the Tories could pursue. Using more of the rapid tests they were so adamant about needing last year would almost certainly help. There’s no end to the ideas being floated as ways to help push our Rt number lower and lower. The only silver bullet is the vaccine, and even that won’t save us until well over half the population has been inoculated. So, in the meantime, there’s just a series of choices — each one pushing us closer to or further from a disaster.

This article has been updated with new estimates related to Ontario's reproductive number.

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