June has been a good month in Ontario’s battle against COVID-19. The numbers are striking, no matter how you look at them. On June 1, there were 801 people hospitalized with the disease in Ontario; as of yesterday, that number was 256. There were 125 people in intensive care; that’s now 61. The number of people on ventilators has similarly dropped by half. The number of new cases proven by tests every day was regularly in the 400s at the beginning of the month; it’s now consistently less than 200 and was only 111 for Thursday. The total number of people known to be actively infected with COVID-19 was 4,000 on June 1 and 1,918 yesterday.
These are all real successes, and both Ontarians and their government can take some credit for them. Indeed, we could fairly argue that, from the perspective of the original argument for shutting down public life in the province in March — the state of emergency, the business closures, and everything that followed — this is a real “mission accomplished” moment: we preserved hospital capacity to respond to the pandemic and kept medical professionals from having to make grisly choices about which patients would get a ventilator and which would not.
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The question for the province now, as MPPs take a weeklong break for Canada Day, is what’s next? Do we accept the current levels of COVID-19 infections as a manageable cost to bear while we reopen the economy? Or do we take further measures to try to wrestle our caseload to the ground, as other places — such as British Columbia and the Atlantic provinces, which this week announced that people will be allowed to travel among them without needing to self-isolate for 14 days — have done?
David Williams, Ontario’s chief medical officer, says that Ontario’s situation simply can’t be compared to those of B.C. or the Maritimes.
“It’s so different — it’s like comparing B.C. to P.E.I.,” Williams said Thursday at his regular Queen’s Park media briefing. “We have a much bigger province; we have 14.8 million people. The only one closest to us is Quebec, and the dynamic is so different here.”
“We’re not down in the ones and zeroes and twos, because we don’t have a province of 1 million people spread over a huge area. We’ve got one of the most dense urban areas; we have huge travel issues,” Williams said. “You see Toronto is now down — the GTA itself is the same size as some of the other provinces totally — and Toronto is only at 58 cases.”
Irfan Dhalla, vice-president of physician quality at Unity Health Network in Toronto and staff physician at St. Michael’s Hospital, says that there are plenty of comparable jurisdictions around the world that have managed to do what Ontario has struggled to do.
“I don’t understand that,” Dhalla says. “Why would it be a realistic goal for British Columbia or Scotland or Thailand or Vietnam or South Korea but not for us?”
Dhalla doesn’t suggest that a new round of lockdowns will be necessary: he believes that better and clearer communication from provincial public-health officials and more aggressive measures to isolate people who have become infected with COVID-19 could help bring Ontario’s case numbers even lower.
He emphasizes, though, that jurisdictions need to set clear goals.
“If we set low expectations, we shouldn’t be surprised when we see that we’ve got more cases than any other province. Seoul is more populous and denser than Toronto; Scotland has a border with England that’s more porous than our border with the United States,” Dhalla says. “If you want to achieve something great, you need to set an ambitious goal and design your strategy around that goal.”
Michael Warner, a critical-care physician at Michael Garron Hospital in Toronto, says the government needs to substantially improve the clarity and communication of public-health guidance — and to support people who can’t adhere to things like 14-day self-isolation periods without help.
“This smouldering slow burn of COVID-19, which is holding back the economy, holding back people’s social interactions, affecting their mental health, will, in all likelihood, continue for several months to come,” Warner says. “There’s no infrastructure in place today to support the less fortunate who need to self-isolate — specifically, financial support, accommodation support, and food support.”
The City of Toronto has proposed a plan to house low-income people in temporary quarantine spaces in currently vacant hotels. Both Dhalla and Warner have endorsed it, but it will need provincial or federal funding to become a reality. Warner has been vocal about the need to do more to contain the spread of COVID-19 in Toronto’s crowded apartment neighbourhoods.
“There’s a perennial disconnect between the bureaucrats, public-health officials, and politicians, on the one hand, and the medical practitioners on the front lines,” he says. “We want to help them — we want a straight line of communications to them so we can tell them what we’re seeing — and that’s been missing from the beginning, and it’s still missing today.”
Both Dhalla and also Warner suggest that a mandatory mask rule may be necessary.
“The public-health units and the province argue over jurisdiction and enforcement; to me that’s just a waste of time,” says Warner. “Canadians tend to follow rules: just set the rule, and don’t worry about enforcement. It’ll become a societal norm.”
The data release from the province on Friday was legitimately good news on almost every front. And July will see a number of substantial additions to the province’s plan to test and trace COVID-19 cases: federal support, for example, will come in the form of interviewers from Statistics Canada, and Ontarians will be able to download a new contact-tracing app to their phones.
But Dhalla notes that new cases still mean new deaths and that it’s likely Ontario will see an increase in new cases as the two largest regions — Toronto and Peel — resume the activities that had been restricted under Stage 1 of the reopening plan.
“And, so, it seems to me that we are gambling that what we’re doing is enough, and I sure hope it is,” Dhalla says. “But I would like to feel more confident that what we’re doing is enough.”