The fog of war is killing Ontario’s pandemic response

OPINION: The government released new modelling Thursday that answers some questions, poses more questions — and is all-around frustrating
By John Michael McGrath - Published on Oct 30, 2020
The province’s chief medical officer, David Williams, discussed updated COVID-19 modelling on Thursday. (YouTube)

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At 3 p.m. on Thursday, the government held its regularly scheduled briefing with medical experts and presented an update on the modelling projections for how Ontario is doing in controlling the second wave of the pandemic. By the time it had wrapped up, nearly an hour later, you’d be hard-pressed to argue that citizens of this province were better informed, on balance, than when it started.

We can at least start with the points the experts wanted to emphasize: there are grounds for optimism in terms of Ontario’s current COVID-19 outbreak, and the modelling suggests that the province’s level of infection will begin to wane without overwhelming intensive-care units. This is important, as hospitals are still digging out from the backlog of procedures incurred because of the shutdown. Earlier this week, the Toronto Star reported that the province’s hospitals are seeing a higher-than-normal level of advanced cancers due to the lack of screening during the first phase of the pandemic, so the costs of another shutdown cannot be ignored.

After that, however, things got muddled quickly.

For example, the province’s chief medical officer, David Williams, said that the province now seems to be on a trajectory similar to that of Michigan, rather than of Victoria, Australia. Insofar as that means our level of infection won’t hit a peak as high as in Melbourne, that’s a good thing. But if we stay on the Michigan trajectory — and we might not! — that could, in fact, be substantially worse news: a lower level of daily new cases, over a much longer period of time, would mean more sickness and death than we’d see in a Victoria-style severe spike and rapid decline.

The catch — and there seem to be nothing but catches these days — is that Victoria brought its COVID-19 numbers down with a lockdown more severe than anything Ontario has seen since the spring. This is exactly the scenario that Premier Doug Ford and his cabinet want to avoid.

Let’s move on to a pretty basic question: Are the “modified Stage 2” measures currently in place in Ottawa, Peel, Toronto, and York regions actually controlling the spread of COVID-19? Based on the data released this week, it’s difficult to say. Numbers in Peel, Toronto, and York have climbed relentlessly since the measures were imposed, but we wouldn’t have expected to see a substantial effect for at least 14 days, based on the virus’s life-cycle. (It’s been 21 days since modified Stage 2 was announced.) Ottawa, on the other hand, has dropped off substantially — but the drop started well before it “should” have, based on that same life-cycle assumption.

It gets even more complicated when you look at the sources of outbreaks, an issue that’s already causing some consternation among observers. Recall that the suspension of indoor dining in bars and restaurants and the closure of gyms and other fitness centres were moves largely predicated on a worrying trend of outbreaks in Toronto (“modified Stage 2” was largely based on urgent requests from Toronto’s medical officer of health, Eileen de Villa). In the province’s largest city — the epicentre of the pandemic — 20 per cent of outbreaks since August 1 have been traced to bars, restaurants, gyms, or “events, ceremonies, and religious services.” That compares to 22 per cent from schools and daycares.

If you wanted to argue that the province’s “targeted” measures are targeting the wrong people and businesses, you can find the numbers to justify that argument in Thursday’s release, but it’s arguably wrong-headed. First of all, opening the schools and keeping them open has been a key part of the government’s policies since August. Angrily shouting, “You’ve closed the bars and restaurants but kept the schools open” doesn’t end the argument — it literally just restates the plan.

More fundamentally, however, nobody should be taking yesterday’s outbreak numbers as gospel, certainly not in Toronto, where 65 per cent of cases haven’t yet been traced to a clear epidemiological link. (It’s nearly half in Ottawa.) The numbers are better in Peel and York regions, where fewer than one-fifth of cases are a mystery. But that should still be enough to make us cautious about drawing hard and fast conclusions about the data.

Which isn’t to say that businesses suffering during the pandemic should be dismissed as simply out of luck. The province and feds have supported them and need to do more. But we also have to understand that they’re paying the cost of these shutdowns because Ontario hasn’t paid the costs of building and maintaining a robust, up-to-date public-health system that can collect and organize the data needed to fight the pandemic.

There’s a “fog of war” in the province’s battle against COVID-19 — a lack of clarity about what the virus is doing, what we’re doing, and whether it’s working — and the way to address it is to spend more money in the public-health system. Yet our public-health units are still struggling with basic resource issues: the same day as the province’s latest briefing, de Villa had to clarify that Toronto’s record-setting case numbers are due in part to workforce issues stemming from illnesses and training needs. Not every problem can be solved by throwing money and bodies at it, but it seems reasonable to suggest that we need enough people working in Toronto’s public-health agency to deal with such things as sick days during an infectious-disease outbreak.

The medical experts did, in fact, on Thursday afternoon call for the “levelling up” of the province’s public-health capacity. But it’s not clear how a recommendation like that will be filtered through cabinet into actual policy. We’ll get a better sense next week, when Finance Minister Rod Phillips rises in the house to present the province’s first budget in 18 months.

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