Health experts say Canada’s hardest-hit provinces have consistently failed to contain the spread of COVID-19 with inadequate and ill-timed restrictions, leaving little choice if much more draconian rules are introduced. But where exactly did we go wrong? And where are we going from here?
Despite declaring lockdowns like they did to control the spread of COVID-19 during the first wave of the pandemic, Ontario and Quebec have been reluctant to impose measures tough enough to prevent a second wave even more deadly, according to some experts.
“The first lockdown was extreme. Everything was closed, everything, and people were really discouraged from even leaving their homes. People were terrified, so they were more likely to comply, ”said Raywat Deonandan, global health epidemiologist and associate professor. at the University of Ottawa.
“Now there is no lockdown – some businesses are closed but many are still open. So people keep going about their business, people keep socializing, because the fear is gone. ”
‘It just keeps getting worse’
In the spring, as much of the country embarked on widespread and severely restrictive lockdowns to stop the mysterious spread of a new virus about which we knew little, the high level of compliance was evident.
“No one was in the street. It was like a neutron bomb had gone off, ”said Dr. Michael Gardam, an infectious disease expert in Toronto and senior medical advisor for Health PEI.
“And if you compare that to today, the highways are full, there are people everywhere. There’s so much more people-to-people contact now than there was in the spring, and I think that’s your answer – it’s not the same lockdown at all. ”
Ontario Premier Doug Ford imposed what he calls a provincial lockdown Boxing Day to tackle the alarming rise in COVID-19 cases, hospitalizations and deaths.
Since then, daily new cases have actually doubled – from 2,123 when restrictions were ad from 21 to 4249 the Friday – although the full impact of the measures has not yet been perceived.
WATCH | The Premier of Ontario pleads with people to follow public health protocols and talks about the state of the pandemic:
“We are in dire straits,” Ford said at a press conference Friday. “There will be other measures because it is getting out of hand. ”
Despite his concern, the Prime Minister has in fact not announced any new measures.
But two weeks after the new lockdown was put in place, the head of the Ontario Hospital Association warns of the impending catastrophe, it is clear to some experts that much remains to be done.
“Ontario continues to go for the ‘lock light’. He’s just not getting aggressive enough, and so you have this slow rise that has really taken everyone to the absolute maximum, ”Gardam said. “Everyone in health care is so exhausted and yet there are more to come and it just keeps getting worse.
The hesitation led to a worsening of the situation
Ashleigh Tuite, infectious disease epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, said the problem is that Ontario and Quebec have tried to be more strategic with their lockdowns during the the second wave.
Non-essential businesses were left open, travel was not effectively restricted, and the provinces only responded when the situation deteriorated.
“At this point, we’re on a pretty scary trajectory if you look at the numbers in intensive care, if you look at hospital admissions and if you look at what’s going on in long-term care,” she says. “If you talk to people who work in public health, there is this sense of dread about what’s happening now and what’s to come. ”
The situation is so bad that Ontario is now preparing hospitals for potentially transfer hundreds of patients in different parts of the province amid a shortage of beds and steadily rising levels of COVID-19 in several hot spots.
Dr. Susy Hota, an infectious disease specialist at the University Health Network and assistant professor of medicine at the University of Toronto, said “critical pressures” on the health care system are even worse now than in the first wave.
“I’m not sure how long hospitals will be able to accommodate incoming COVID patient volumes,” she said. “Maybe we can hold our fort a bit, but at any moment we can switch. ”
In response to the worsening situation in hospitals and the unprecedented surge in COVID-19 cases, the Ontario government appears to be hesitant once again before deciding to implement new restrictions.
“We have to approach this situation as the crisis it is. We also need to embrace the mindset that every day is a new day, and start over with our approach when necessary, ”said Dr Irfan Dhalla, vice president of physician quality at Unity Health, which includes St. Michael’s Hospitals and St. Joseph of Toronto.
“We need to communicate clearly and not send conflicting messages. We must use restrictions and locks to drastically reduce transmission, and only open up when we have the capacity to contain the virus through public health interventions such as testing, contact tracing and quarantine. ”
WATCH | Quebec imposes a curfew:
Quebec has taken the extraordinary step of setting up an 8 p.m. to 5 a.m. curfew, which will start on Saturday and last for four weeks, the first of its kind in Canada since the start of the pandemic.
“The coming month is going to be critical,” Prime Minister François Legault said at a press conference on Wednesday where he announced the new measures. “We are in a race against time. ”
But the reviews were quick to highlight the new restrictions did not include any limits on the manufacturing or construction sectors or an extended break for schools, which, combined, have accounted for a large chunk of outbreaks in recent weeks.
“All policymakers can do is create environments and incentives and disincentives to encourage certain behaviors,” Deonandan said.
“At the end of the day, it’s always up to people to do what needs to be done. ”
Stricter measures will work?
While the decision to impose a curfew has be under fire experts and health advocates and the effect it will have on COVID-19 levels in Quebec remains to be seen, Hota says it will likely have an impact.
“It certainly sends a clear message to people that we are not expected to see people on the streets,” she said.
Its success will depend on its application, she said.
“If you break the rules, then who’s really going to call you?” Or are we just going to let it happen?
Gardam says a tougher lockdown in Ontario would likely help bring cases down to manageable levels. He suspects that the government’s reluctance may be due to potential political fallout.
“The solution is available and it has been proven to work,” he said. “It’s really unpleasant for politicians to do this, and so they keep getting around it. ”
Gardam says that if Ontario instituted the type of lockdown that Australia successfully used to control the spread of COVID-19 in its first wave, the province would be in a much better position.
When Australia was hit by an upsurge in COVID-19 cases at the end of July, it caused one of the world’s longest lockdowns in Melbourne, which shut down virtually everything that was not a grocery store or hospital for almost four months.
“If you put in a very strict lockdown like this, your cases would fall,” he said. “We have a lot of evidence of this in other parts of the world. ”
He said the length of the lockdown would depend on how quickly cases dropped.
Deonandan said he was concerned that tougher lockdowns could lead to greater public resistance.
“At the end of the day, if people don’t want to comply, it will fail,” he said. “The more we impose these restrictions, the more likely people are to push them back.”
While the best approach would be to try to reduce the number of cases as quickly as possible, this may not be politically or psychologically possible, he said.
“Do I think people have a tolerance for this? Honestly, I don’t think so. ”
But Hota says anything that isn’t under drastic restrictions now will fail to respond to a second wave that’s about to spiral out of control in hospitals.
She admits that it’s a lot to ask, given that people have already been told to stay home for almost a year at this point. But the reality, she said, is that it will take more than just a four week breaker-type lockout to change things.
For this to work, you need to provide very clear advice on what is allowed and what is not, she said.
“If we choose not to, we have to live with it, which is not sustainable from my point of view. ”
The key, according to Dhalla, is to better apply everything we’ve learned over the past 10 months so that we can contain the pandemic once and for all.
“Then we can manage sporadic local outbreaks the way they’re handled in Asia, Australia and New Zealand, while still continuing to immunize people as quickly as possible. ”