As some regions in Ontario head into second week of lockdown, cases of in the province continue to climb with five more health units moving into an escalated risk category — with greater restrictions — in an effort to tamp down infections.
“Obviously we need patience, which is tough because we’re still seeing an unacceptable number of new cases per day,” said Dr. Isaac Bogoch, an infectious diseases specialist at the Toronto General Hospital Research Institute and the University of Toronto.
“But we wouldn’t expect to see any meaningful changes for around 10 to 14 days. It’s a little too soon to gauge whether this is successful or not.”
On Monday evening, Ontario’s local public health units reported a total of 1,832 confirmed or probable cases of COVID-19 and 13 deaths. This brought the rolling seven-day average to a new high of 1,657 cases per day.
Bogoch said that he thinks more needs to be done to address the underlying drivers of infection in the community that may not be impacted by the lockdown policy.
“There are a lot of sectors in the economy that are still open and people might be at risk in those areas. In addition to that, there might be people who are at risk in those areas who go to intergenerational homes and infect other people,” he said. “There still may be people having private gatherings and getting together in their own homes. So these are other drivers of the epidemic in Ontario that are more challenging to address.”
Here we take stock of Ontario’s battle against COVID-19 with expert commentary and check in on some European nations to see how they compare with Canada.
Toronto and Peel remain under lockdown
Public health officials in Peel have been targeting some of the underlying drivers of the pandemic, including unco-operative businesses that have had cases or outbreaks.
On Nov. 16, came into effect in the region that imposed a $5,000-a-day fine to employers and operators who didn’t take the necessary action to prevent or stop the spread of COVID-19.
Dr. Lawrence Loh, Peel’s medical officer of health, said that although many businesses were co-operative, there were some that were not “participating in our investigations or taking steps to protect their workers” such as directing an infected employee to stay home, he said, adding that he’s seen a higher level of compliance since issuing the order.
Cases continue to rise in the region, but more slowly, said Loh, which he thinks is a combination of the positive results of the Section 22 order and the lockdown, combined with more cases as a result of Diwali and Bandi Chhor Divas festivities two weeks ago.
Like Bogoch, he thinks we could see the results of the lockdown by the end of this week.
“That’s what I’m hopeful for at least, that we’ll see a plateau and then hopefully it will start to decline,” said Loh.
Toronto reported 643 cases on Monday, a new high for daily cases, which have fluctuated over the last week, from a low of 331 last Monday.
Dr. Eileen de Villa, the city’s medical officer of health, said in a press conference Monday that the “infections we’re seeing lately occurred now a week or even two weeks ago,” a reminder that the city is still in the early days of the current lockdown.
“High case counts are in a large part under our own control. By the same token, so is getting our case counts down,” said de Villa. “I know there is a real awareness of what we can do on an individual basis to play our part, as I know many, many people are doing. And I’m confident that we are going to see good results if we do just that.”
Deaths in both Toronto and Peel have accelerated recently.
Since the beginning of October, 421 people have died in Toronto from COVID, compared to 22 deaths in the two months before.
“We know death is a lagging indicator,” said Bogoch, “and certainly I wouldn’t be surprised if they climbed some more. It takes time.
“But when we start to see 1,500 to 1,700 new cases a day … some of those people are going to be hospitalized, some of those people are going to require intensive care and some of those people are going to succumb to the illness.”
“Sadly we have to take a stay-tuned approach because we’re going to see those numbers rise.”
Five regions in Ontario step up restrictions
Windsor-Essex county has 424 active cases, ranking it number 10 in the province for active cases. The health unit was moved into the red, or control, category by the province Monday, which means indoor social gatherings will be limited to five and restaurants can have a maximum of 10 people indoors, although weddings and funerals can continue at 30 per cent of venue capacity or 100 people out of doors.
The area has a population of 428,556 residents, about 50,000 fewer than Niagara Region, and more than double the active cases, according to an analysis by the Star’s Andrew Bailey.
In a press conference Friday, the area’s medical officer of health told residents to keep a diary of their whereabouts to aid public health’s ability to contact-trace should it become necessary.
“Have a plan,” said Dr. Wajid Ahmed, the area’s medical officer of health. “Don’t wait for public health to tell you to isolate and to do all of that.”
Ahmed said that for the last three weeks, an average of 40 or so cases are being identified every day and are putting significant strains on public health.
There are also numerous outbreaks in the region, including seven at workplaces and one at a hospital that Ahmed said he didn’t declare lightly because of the strain it would put on the community.
“The bottom line is we are getting worse,” said Ahmed. “We definitely don’t want the entire public health system to collapse. Or the acute-care system to collapse.
“We don’t have three or four hospitals in the region that can support this redirection of patients. Declaring an outbreak at the hospital, it was not an easy decision. We recognize it will have a huge impact with patient admissions and transfers.”
The province also downgraded four other health regions, moving Haldimand-Norfolk to orange, or the restrict category, which means intermediate measures such as limiting indoor private social gatherings to 10 people and to 50 for indoor organized events.
Hastings and Prince Edward Counties Public Health, Lambton Public Health and Northwestern Health Unit moved to the yellow, or protect category.
Norway shows the way
In Europe, leaders are trying desperately to bring down daily COVID-19 infections through a series of restrictions in advance of the Christmas holidays. And in at least one European nation — Norway — there are signs that infection control measures may have started to pay off.
In early November, the country introduced its strictest rules to date in an effort to curb the spread. These included limiting private gatherings in public spaces and rented venues to 20 people; denying entry to travellers from high-risk countries unless they show proof of a negative COVID-19 test taken within the last 72 hours; a recommendation that people stay at home as much as possible; and a ban on serving alcohol in restaurants and bars after midnight. In the capital, Oslo, settings where people congregate, such as cinemas, theatres and swimming pools, were shut down, while the serving of alcohol at any establishment at any time was banned.
“There is light at the end of the tunnel. We must hold on,” Norway’s Prime Minister Erna Solberg said last week.
Three weeks ago, Norway and Canada had close to the same number of daily new confirmed cases per million (about 107 cases on a rolling seven-day average basis). As of Nov. 29, the trends in the two countries have diverged substantially, with Norway down to about 58 new daily confirmed cases per million and Canada up to about 144 new daily cases per million.
The European Centre for Disease Prevention and Control reports that Norway currently has a 14-day cumulative number of COVID-19 cases per 100,000 of 141.2, the third-lowest in Europe (Iceland and Finland, respectively, have the lowest of these measures).
One of the reasons for Norway’s relatively good fortune to date, is its relationship between citizens and government, said Dr. Colin Furness, an infection control epidemiologist at the University of Toronto.
“It’s a socialist country,” he said. “They accept very high taxes and they get in return a lot of government services. So there’s a lot of orientation to the collective right there. Show me a population that rails against paying taxes and I’ll show you a population that favours inequity and every man for himself. Which population is going to do better when you need to have collective action?”
He added that the decision to suspend alcohol sales was smart. “If you think culturally, what they’re really saying is, restaurants are not the place to be. At home is the place to be, and that’s where the alcohol is.”
English woes
On Wednesday, England’s month-long lockdown will come to an end, but new restrictions will immediately come into place. The country will be broken up into three “tiers” depending on the severity of risk of infection. Most of the country will be in tiers 2 and 3, or “high” and “very high.
“They are definitely not out of the woods,” said Furness. “Public Health England has done an extremely bad job and the government that is trying to direct the show has done a worse job. It’s a real mess.”
London, for its part, will avoid Tier 3 and enter Tier 2, meaning bars and restaurants can reopen, along with gyms, shops and personal care services. Regions in Tier 3 will see their bars, pubs, cafés and restaurants stay closed, along with indoor entertainment venues, such as cinemas. Officials are also telling people living in Tier 3 areas not to travel outside their regions.
Major cities to remain in Tier 3 include Greater Manchester, Bristol and Birmingham.
The U.K. currently has Europe’s third-highest 14-day cumulative number of cases per 100,000 at 372, just behind Spain and France. The U.K. also has the third-highest number of cases since the pandemic began (1,617,327), behind Spain (1,628,208) and France (2,218,483), according to the European Centre for Disease Prevention and Control.
“Countries that have done reasonably well, Iceland, Taiwan, New Zealand, they’re islands. They can literally pull up the drawbridges and say we’re not going to welcome people and we’re not going to travel for a while. The U.K. could have done that but they didn’t.”
Clarification – Dec. 1, 2020: This article was edited from a previous version to make clear that some regions in Ontario are heading into second week of lockdowns, not all of Ontario.
With files from Ed Tubb
Patty Winsa is a Toronto-based data reporter for the Star. Reach her via email:
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email:
