An epidemiologist who sits on the provincial government’s scientific advisory table says it’s clear what needs to be done in Ontario to stop the spread of COVID-19.
Number one: Implore the one-quarter to one-third of Ontarians who are not following the rules to do so.
“Two-thirds to three-quarters of people are adhering,” said Peter Juni, a professor of medicine and epidemiology at the University of Toronto and the director of the Applied Health Research Centre at St. Michael’s Hospital.
“Now we just need to get the remaining one-quarter to one-third to help us,” said Juni, who is scientific director of Ontario’s COVID-19 science advisory table. “If they start to adhere to the measures. it is absolutely doable and we will bend the curve between the next two to three weeks.”
Second and third on the list, he said, is to further reduce the number of people who are going out to shop — now at about 50 per cent of pre-pandemic levels — and lower the percentage of people who are leaving home for work.
“We need to really be careful with what we define as essential work,” said Juni, who notes mobility data shows 60 to 70 per cent of people are commuting. He believes many people returned to the office after the holidays because it was easier to work there.
“Essential work should not become an (excuse) for going to the office.”
But a definition of what is essential is just one of the many particulars missing from the province’s latest lockdown plan, which has left police in the precarious position of deciding why people should be out and about.
Premier Doug Ford announced the plan Tuesday, which included a stay at home order and state of emergency, telling Ontarians to go out for essential reasons only, but allowing non-essential businesses to stay open from 7 a.m. to 8 p.m.
An emergency alert from the government on Thursday said people could only go out for “essential purposes such as food, health care, exercise or work. It is the law.”
Stay at home orders have been used in a number of jurisdictions, including Australia, where police have been accused of “abusive practices” by Human Rights Watch.
With a record number of cases here, the approach has left some experts here wondering why a more stringent lockdown that doesn’t hinge on the definition of essential is not in place.
“If we know the current grey level hasn’t done anything, what’s the evidence the new lockdown will help?” said pandemic modeller Dionne Aleman, referring to the lockdown measures previously imposed under the province’s colour-coded response framework.
Modelling showed that those measures weren’t working to control the pandemic and forecasted “an overwhelming of the health system unless drastic action is taken,” said a spokesperson with the Ministry of Health.
“This order and other new and existing public health restrictions are aimed at limiting people’s mobility and reducing the number of daily contacts with those outside an immediate household,” the ministry said.
But the government didn’t specifically set out what it considered “essential” or shut everything down as it did in the spring.
“It all comes down to the details of what is and isn’t essential,” said Aleman, who is also an associate professor of mechanical and industrial engineering at U of T. “And as we’ve seen time and time again when the province rolls out new measures, there’s a complete lack of detail that comes out when the measures of implemented.”
“Just looking at ICU numbers, not even looking at projections but where we are right now with our hospitals, is standing on the edge of a cliff,” Aleman said. “Fifty per cent of hospitals in Ontario have two or fewer ICU beds available, 25 per cent have zero ICU beds available. Those are shocking numbers.”
The government has taken a similar approach to the construction industry, allowing essential projects to continue and issuing a lengthy list of the types of projects that qualify including critical ones in health care, energy, mining and schools as well as some residential construction.
Those decisions were made based on advice from the chief medical officer of health, said a spokesperson with the Ministry Labour, Training and Skills Development.
“Workplace transmission on construction sites remains extremely low compared with other sectors and industries,” according to a labour ministry spokesperson. “The public WSIB data shows we’ve had only 93 confirmed COVID claims in construction among a total of over 10,000.”
The spokesperson said continuing projects, when done safely, “will help to drive the province’s economic recovery.”
In the wake of the Ontario government’s announcement Tuesday, Toronto politicians and those in other municipalities scrambled to go through dozens of pages of guidelines from the provincial government.
Even Juni, who is focused on a collaborative effort with the government and not criticism, said current measures have failed to define what is essential.
“If the measures need to be enforced, we would need to become specific about what is deemed essential and what is not — without specific, clear definitions, it is challenging to enforce the measures,” he said.
But with his focus on collaboration he noted the benefits of finding a definition.
“A more critical look at what is really essential and what is not will help to further decrease unnecessary mobility and contact rates,” Juni said. “This includes a close look at what kind of construction is really essential, and what can be interrupted.”
The new government restrictions also leave out a key component that many public health officials have said is vital to turning things around: paid sick days. Juni called that a “big absence.”
Aleman said the government has been tap dancing around questions concerning more paid leave.
“We have an adage in industrial engineering: Every system behaves exactly as it is designed to behave,” she said. “The current system does not incentivize people to stay home through sick leave and sufficient financial support, and not that many people are forced to stay home by provincial orders. Thus, people continue to have lots of contacts, and COVID continues to spread.”
But Juni said that other Ontarians, who have the means to stay home, shouldn’t need the government to tell them to do the right thing.
“What we know is that every single measure that reduces contact rates is likely to be effective,” he said, “but we always have a certain amount of the population that tries to escape the measures.”
He likens going out in Toronto to Russian roulette, with the potential that one in 20 people is infectious. The odds that a person will end up in hospital are much lower, but there’s still a chance that one out of a 100 or 200 people, aged 30 to 39, could need treatment. The odds go up as you get older.
“And being hospitalized for COVID-19 is really not a walk in the park,” said Juni. “Seventy to 80 per cent of those hospitalized will have long-term consequences of COVID-19 six months or longer after being affected.”
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