Ontario won’t be Italy, but it won’t be back to normal for a long time

The worst-case scenario for Ontario planners seems to be receding, as the province still has ample ICU beds. That doesn’t mean everything’s okay 
By John Michael McGrath - Published on Apr 14, 2020
Premier Doug Ford holds a media briefing on COVID-19 following the release of provincial modelling on April 3. (Frank Gunn/CP)

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It’s not yet time to pop any champagne corks, but there’s real reason for optimism in Ontario this week: the “Italy scenario” has not yet manifested in the province’s hospitals and intensive-care units, and, if the present projections about COVID-19’s peak prove correct, we’ll escape it entirely.

To refresh everyone’s memory: for Ontario, the Italy scenario would have involved COVID-19 growing exponentially to the point that the province’s ICUs ran out of ventilators and doctors were faced with the nightmarish obligation of picking and choosing which patients would be treated with a ventilator and which would have to face the much higher mortality risk of trying to get through without one.

That’s the scenario Ontario has spent weeks preparing for, and it’s the scenario the province has been working desperately to avoid. It’s what’s spurred all the public-health measures that have been introduced to date, including the closure of schools and non-essential businesses. For now, the threat seems to be receding: the number of confirmed COVID-19 cases in the province’s ICU beds on April 12 was 263; when the government briefed the public on its projections two weeks ago, that number was expected to be more than 1,000.

More important than the absolute numbers is the fact that the province’s ICU capacity is holding up under the strain. This arguably might not have been true if the government hadn’t been able to rapidly expand the number of ICU beds and ventilators (and there are more on the way). If Ontario’s outbreak does, in fact, peak this week — as Barbara Yaffe, the associate chief medical officer, suggested yesterday that it might — we won’t hit the terrible threshold of having more critical COVID-19 cases than ventilators.

(This week’s numbers could, of course, turn around and give us a horrible surprise. And solid provincewide numbers don’t mean there won’t be local hot spots that warrant our concern.)

There are at least two dark clouds in this silver lining. The first is that, while the general population in Ontario may be at lower risk from the pandemic going forward, the situation in Ontario’s long-term-care homes — and other places where people live in close quarters  — remains dire. Of the province’s 291 deaths, 40 per cent have come from long-term-care homes, where the combination of elderly and densely packed residents and precarious work conditions among staff — who have needed multiple jobs at different facilities to make ends meet and have therefore moved the virus around with them — have created a perfect storm.

Prisons and homeless shelters should also be on our radar: Toronto’s medical officer of health, Eileen de Villa, said Monday that 25 people in the city’s shelter system have tested positive for COVID-19, and hundreds of medical professionals have called on the city to redouble its efforts to halt the spread of the virus in the city’s shelters, arguing in an open letter for the opening of hotel rooms, housing units, and student residences.

The other dark cloud: even if this week’s positive signs materialize in a true peak of the disease in Ontario, it will be quite some time before life even starts to return to normal. Later today, MPPs at Queen’s Park are going to vote to extend the current state of emergency until May 12, and readers should be ready for it to be extended at least once more after that. The government’s legal authority to impose all the public-health measures that have worked reasonably well thus far stems largely from the state of emergency, so as long as they’re necessary, MPPs will need to renew it. Even after the provincewide measures are lifted (whenever that happens), local public-health officials will likely retain a number of policies to deal with their specific contexts.

Some measures may be lifted sooner than others: it would be nice if, before Canada Day,  people could gather in modest groups without risking a fine; reopening some form of child care for the general public will likely be a top priority for the government. But the question the government is only starting to turn to now is what a post-peak world will look like — and how it can go about supporting a return to public life without risking a new outbreak.

We’re able to plan for that day, however, only because the restrictions are doing the work they’re intended to. They will need to stay in place — we will need to keep at this — for a while longer.

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