To end the lockdown, we’ll need more than just falling case counts

OPINION: Vaccines have started to work their miracle in Ontario, and new COVID-19 cases seem poised to fall rapidly. But that may not be enough
By John Michael McGrath - Published on May 11, 2021
Even as vaccines roll out across Ontario, we’re at the mercy once again of lagging indicators. (Lars Hagberg/CP)

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Throughout the pandemic, Ontario’s chief medical officer of health, David Williams, has been notable — or notorious — for not pinning the government to many clear thresholds for action. Want to know how many COVID-19 cases it takes to force a provincewide lockdown? “That’s a good question.” How about what number of ICU patients we’d have to reach before halting elective procedures? “Well, it’s a complicated situation with many different variables.” On the few occasions when the government has laid out clean benchmarks for action, we’ve tended to pay close attention.

So it was on Monday afternoon, when Williams stated that the current stay-at-home order would need to be extended until the province had seen an extended period of relatively low daily case numbers.

“We want that number down … I think it has to be well below 1,000,” Williams told reporters at Queen’s Park. “Can we get down to 500-600 a day? If 70 per cent of your population is vaccinated, I think that’s not only reasonable — it’s achievable.”

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Premier Doug Ford’s cabinet is debating this week whether — or, more likely, by how much — to extend the stay-at-home order currently slated to end on May 20. Williams, as one of the premier’s closest public-health advisers, obviously carries a lot of weight, but it’s fundamentally cabinet that declared the new state of emergency and authorized the new stay-at-home order, and it’s cabinet that will make the ultimate decision to extend or rescind the order. And Christine Elliott, the minister of health and deputy premier, said earlier on Monday that the province’s key health indicators would need to come down quite a bit before the government would consider lifting the order.

But something else Williams said suggests that we shouldn’t put the champagne on ice the moment the province’s numbers dip below 1,000 for the first time, even just in anticipation of more good news to come.

“The ICU numbers … we weren’t even talking over 500 back in the second wave. We have a ways to go. We’ve got to get all those patients repatriated again,” Williams said. “How low do we need to go?”

Williams suggested that the province will be aiming to reduce the (extremely concerning) number of patients in the province’s intensive-care units from the current 802 to something more in the 150-200 range, a decline of about 75 per cent.

Although the wave of ICU patients in Ontario’s hospitals seems to have crested and is now slowly receding, it’s difficult to overstate how bad the situation in the hospitals got and how much harm needs to be undone. The most immediate priority, as Williams alluded to, is simply getting the sick patients who were transferred across the vastness of this province during the third wave back to their home communities.

But we also need to get hospitals back to something approaching normal operations again as soon as possible so that important surgical and diagnostic procedures can resume. The Financial Accountability Officer estimated this week that it’s going to cost $1.3 billion and take three and a half years for the current backlog of procedures to work its way through the system, absent some novel measures to increase capacity. Tackling the backlog can’t begin in earnest until ICU capacity hits that 150-patient benchmark.

Unfortunately, even as vaccines work their miracle in Ontario, we’re at the mercy once again of lagging indicators. The people who are being moved into ICU beds today are the people who first got sick days ago, and they may need to stay in those beds for weeks to recover the use of their lungs. The fact that the number of new cases is falling is obviously good (it would be better still if we were testing more aggressively to be sure that we’re catching every case we can). As new cases fall, indicators across the board will improve, too — but it’s all going to take time. After the peak of the first wave, it took about two months for the number of ICU patients to fall by 75 per cent; we were never able to achieve such a decline after the second wave, because the third wave arrived.

We will get there, and I’m still optimistic about the summer, but Ontarians are likely going to be asked for a little more patience before this is all over.

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