The province rejected advice from its own public health agency when it created its new colour-coded framework for COVID-19 restrictions, and the executive leading the organization’s pandemic response says she only learned of crucial details when they were released publicly last week, the Star has learned.
Health Minister Christine Elliott told reporters Friday that the framework was “designed after full consultation and advice” from two expert advisory groups — the public health measures table and the modelling consensus table — as well as chief medical officer of health Dr. David Williams.
But one group said it was never consulted, and a member of the other group said she never saw the final plan before it was released. In interviews with the Star, they described the framework’s controls as insufficient to contain the spread of the virus, putting Ontario’s health-care system and its most vulnerable citizens at risk.
In September, Public Health Ontario was asked by the Health Ministry to provide advice on epidemiological indicators for the framework, said Dr. Shelley Deeks, the agency’s chief health protection officer, who also sits on the province’s health measures table.
PHO provided advice for four levels of control measures. To move into the strictest level short of a full lockdown — a category now known as red or “control” — PHO recommended a threshold of a weekly infection rate of 25 cases per 100,000 people and a lab test positivity rate of 2.5 per cent, Deeks said.
But in the final plan, which Deeks said she saw only last Tuesday when it was announced to the public, these thresholds were set four times higher: at 100 cases per 100,000, and 10 per cent.
“That surprised me,” she said in an interview, adding that she stands by the thresholds PHO advised back in September. “I’m not in agreement with the indicators as they are currently written in the framework.”
Beate Sander, co-chair of the Ontario COVID-19 Modelling Consensus Table, said minister Elliott “misspoke” at a Friday press conference when she said members of her group had provided advice.
“The Modelling Consensus Table was not consulted,” said Sander, a scientist at the University Health Network and Canada Research Chair in Economics of Infectious Diseases, adding that she and other members of the scientific community were “surprised” by the plan.
“I agree that the thresholds are very, very, high,” she said.
“The risk is that we are not going to be able to control case numbers increasing, which means we are also risking our hospitals being overwhelmed. In some of the areas where there are already high case numbers, we have started seeing that already.”
Provincial officials say the framework was intended as a “proactive” plan that would provide clarity and predictability for the public and businesses, many of which are struggling to stay afloat and plan ahead in the face of abruptly changing health measures.
Experts have criticized the framework for being dangerously lax. Health units in hot-spot areas, like Peel and Toronto, have since introduced additional measures of their own to try to get their spiralling epidemics under control.
Under the province’s plan, Toronto is set to enter the red “control” level on Saturday, which would reopen indoor dining and bars, fitness classes, casinos and bingo halls. But on Monday, Toronto medical officer of health Dr. Eileen de Villa invoked her legal authority to keep these all closed, citing the city’s surging case counts and test positivity.
The Star asked the Health Ministry for the names of the health experts and advisory bodies that proposed the thresholds for each level. The ministry did not respond to this question but said the framework was “informed by data, evidence and information, including from other jurisdictions, and approved by Cabinet.”
“Public health experts such as the Chief Medical Officer of Health, Office of the Chief Medical Officer of Health, Public Health Measures Table and local medical officers of health provided input on the overall concept and direction for the framework,” spokesperson Adam Hendy said.
Deeks sits on the public health measures table as a representative of PHO, where she is executive lead of the public health response for COVID.
Both PHO and the health measures table advised the province on its reopening framework, Deeks said. But because the public health measures table’s advice to the province is confidential, she declined to share details of those conversations.
Deeks said she supports the province’s decision to release a framework with different categories of control, and clear indicators that support moving from one level to the next.
“I think that the increase in restrictions or public health measures grounded in indicators is actually a really helpful thing,” she said. “And I think it’s helpful to communicate that to the public so that they understand.”
But the indicators PHO recommended are nowhere to be found in the province’s final plan. In the lowest level — now known as green or “prevent” — the province’s thresholds are twice as high as what PHO recommended, which was a weekly incidence rate of 10 per 100,000 and a positivity rate of one per cent, according to Deeks.
And at the highest “control” level prior to going into lockdown, the province’s indicators are four times higher than what PHO recommended — meaning it will take much longer for regions to tip into this category and impose necessary measures.
Deeks acknowledged that she only has to consider these thresholds from a disease control perspective, and doesn’t face the government’s difficult task of also having to weigh societal and economic considerations.
But she explained that PHO’s recommendations were grounded in the understanding that early action is crucial for controlling COVID. When she looked around at other jurisdictions, the lesson was always the same: the steeper the rise in new cases, the longer — and harsher — the control measures required.
“We’re taking action earlier to prevent the need for more aggressive action later on,” she said. “It’s actually harder to control a disease when there is much more of a disease around.”
“Delaying more severe measures or tighter measures means generally that we will be in it for a longer period of time, because at that point, it’s just so out of control that it takes us much longer to to get back to a level that we can manage easily, where we can have some kind of semblance of normal life.”
Deeks said recommendations also need to consider the reality that more vulnerable populations have been hit harder by the pandemic, including elderly residents in long-term-care homes. “That’s worrisome to me because we know with COVID, they are more likely to get seriously ill, and so it’s more difficult to control when it’s in that population.”
She said a vaccine is now on the horizon, and a glimmer of hope. But the current numbers in hot spots like Peel and Toronto are already worse than they were in the first wave and we are not yet at this wave’s peak, she said.
Deeks’s voice broke with emotion when she spoke about the effect the epidemic will have on vulnerable populations, and the sacrifices that will be required to keep everyone safe.
“I know that it is tiring, that people are tired,” she said, struggling to maintain her composure. “I’m really scared with numbers like this that it will spill again to the elderly and we will see more deaths.
“I think it’s going to get worse before it gets better, and we need to be prepared for that. And we need to act.”
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