So Doug Ford has a COVID-19 second wave plan. But is he miscalculating the trade-off for what could be short-term economic gains?

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It’s not that the province doesn’t have a plan. You may have worried about this over the past few weeks as the number of COVID-19 cases has risen and worried experts have screamed and Ontario has done nothing. The province has suspended its reopening and ultimately lowered some collection limits. Nothing else, however.

But it turns out Ontario has a plan. He is late, reactive and possibly nearsighted. But there is a plan, okay.

“Of course, they don’t want to shut down any part of the economy that is currently on the move,” says Dr. Andrew Morris, professor of infectious diseases at the University of Toronto and medical director of the Antimicrobial Stewardship Program at Sinai. -University health network. “Although what we do know is that the growth in the number of cases is not going to stop in the next two weeks, there is nothing that has been announced today that will make us believe that there will be a reduction in the growth of cases in the next two to four weeks, even.

“Over the next two, four, six weeks, I don’t see any likely outcome other than that they’re going to have to increase the restrictions.”

But the province does not want to do that, and it is the tension that is at the heart of this plan that is causing so much noise. Premier Doug Ford on Tuesday announced a campaign to expand the flu vaccine, but held back on other aspects, saying, “This is a massive, massive and very robust plan. It is full of objects. If we pose everything at the same time, the message will not get to people. ”

On Wednesday, plagued by impractical test queues, the province announced that 60 pharmacies will offer testing to asymptomatic people, by appointment only, starting Friday. Several pharmacies appear to have been taken by surprise by the announcement. Maybe the message has not reached them.

On Thursday morning, the provincial deputy medical officer of health, Dr Barbara Yaffe, directed an ad so confusing that 25 minutes into a reporter had to ask what exactly he was announcing. The result was significant: Asymptomatic people should only be tested at designated pharmacies, by appointment, when leaving assessment centers for symptomatic people, who have had clear exposure to COVID-19, or have jobs in high risk.

This was necessary, given the lack of responsiveness to delays in testing. Why this announcement could not have been combined with the pharmacy announcement the day before was unclear.

Thursday came a provincial pledge to hire more contact tracers, a plan to expand screening capacity and an attempt to understand how to better communicate public health metrics, as well as push for private medicine to help reduce the surgical backlog. The province said $ 1.07 billion would be spent. There is surely more to come.

Never mind the shambolic deployment. And yes, a lot of this could have been done in the summer, when cases were low, as a second wave was widely anticipated. The province could have spent money to boost testing earlier, and contact tracers could have been hired at any time, and when it comes to public health communication, this issue has long been clear.

Yet, it’s never too late to make better decisions. It won’t change our course now. Today’s cases show what happened 10 to 14 days ago; changing Ontario’s course in about two weeks – and the seven-day average is now 403 cases per day, up from 228 cases 10 days ago – would require immediate intervention.

And it’s not yet, and the question is how far Ontario will let it slide for what may be short-term economic gains.

Thirty-eight Ontario health leaders, including influential infectious disease figures such as the University of Toronto and Allison McGeer and Dr Morris of Mount Sinai, signed a letter distributed by the Ontario Hospital Association, which called for “immediate restrictions on non-essential businesses and activities that facilitate social gatherings and increase exposure opportunities, including restaurants and bars, nightclubs, gyms, theaters and places of worship . Basically tighten up, if not shut everything down, and get ahead of where the virus will go.

“Well, we’re taking these steps (so) we don’t have to,” Ford said. “The reason we’re doing this, we want to avoid shutting down the economy for as long as possible, because I think it would be extremely, extremely difficult for a very large number of people.

No one underestimates the effects of economic shutdowns. But the path of the pandemic to economic health is first public health, then the economy. Ford doesn’t seem to understand that what it announced this week won’t have much of an effect on the number of actual cases in the near future.

“Honestly, I don’t know what the right balance is,” says Dr. Isaac Bogoch, infectious disease specialist at the University of Toronto, noting Dr. Bonnie Henry’s interventions in British Columbia. “But the more we let it spiral, the less effective local public health measures will be. And your options get smaller and smaller as cases increase in the community. “

Morris noted that the children were not significantly present in the first wave, because they were not in school; now, inevitably sick children will exert a corresponding pressure on health care, education and all facets of the economy.

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“It’s all going to sink,” Morris said. “So right now we’re at about 400 cases (per day), and the doubling time is about 10 days, so we’re probably going to have about 800 cases in 10 days. COVID-19 is a behavioral disease, and unless you can affect human behavior … you can test, trace, and isolate whatever you want, but unless you can change human behavior, you’re going not alleviate the disease.

“There’s no doubt in my mind that (the province) knows this, but the complexity of tackling it for it, and the liking for them to tackle it right now, is obviously not high for the moment.

There is no proof that this government was ready for the second wave at the beginning of September, but it is over now. Now it is up to Ontario to find the balance between the economy and public health. And unless they strike the right balance, the two could well go to hell.

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