A new briefing note from a panel of science experts advising the Ontario government on COVID-19 shows a province at a tipping point.
Variants that are more deadly are circulating widely, new daily infections have reached the same number at the height of the second wave, and the number of people hospitalized is now more than 20 per cent higher than at the start of the last provincewide lockdown, states an analysis from Ontario’s COVID-19 science advisory table published on Monday night.
“Right now in Ontario, the pandemic is completely out of control,” Dr. Peter Juni, the table’s scientific director and a professor of medicine and epidemiology with the University of Toronto, said in an interview prior to the briefing note’s publication.
That stark assessment follows weeks of warnings from medical professionals in Ontario over rising case counts and fast-spreading variants. It comes the same day B.C. announced it will be implementing a three-week “circuit breaker”-style lockdown, with sweeping new restrictions on indoor dining in restaurants, group fitness and worship services.
Juni said for Ontario, there is now “no way out” of the dire scenario that’s set to unfold over the next few weeks without a widespread lockdown as well — coupled with other measures, including the province providing paid sick leave to essential workers, encouraging Ontarians to avoid movement between regions, and ensuring residents have access to lower-risk outdoor activities.
“There is no such thing as winning this race with just vaccinations,” Juni stressed. “That’s impossible.”
Variants now 67% of Ontario infections
The table’s latest analysis, first reported by CBC News on Friday, shows new variants of concern now account for 67 per cent of all SARS-CoV-2 infections in Ontario.
Compared with the early strain that circulated, the variants — which are primarily B117, the variant first identified in the U.K. — are proving to cause more severe illness.
The briefing note outlines that the variants are associated with a more than 60 per cent increased risk of hospitalization, a doubled risk of admission to intensive care, and a 56 per cent increased risk of death.
By March 28, the daily number of new SARS-CoV-2 infections in Ontario also “reached the daily number of cases observed near the height of the second wave, at the start of the province-wide lockdown,” on Dec. 26, 2020, the note reads.
Toronto-based geriatrician Dr. Nathan Stall, a member of the science table, said Ontario is “repeating the same mistakes over and over and over again.”
“We continually fail to protect the most vulnerable,” he continued. “First it was long-term care, now it’s community-dwelling older adults [and] essential workers.”
The number of people hospitalized with COVID-19 is now 21 per cent higher than at the start of the province-wide lockdown, while ICU occupancy is 28 per cent higher. The percentage of COVID-19 patients in ICUs who are younger than 60 is about 50 per cent higher.
“We’re seeing this shift of who’s in the hospital and who’s in the ICU right now … that’s worrying,” said University of Toronto epidemiologist and researcher Ashleigh Tuite, the lead author on the briefing note.
Emergency and critical care physicians have also highlighted that trend, noting anecdotally in recent weeks that patients appeared to be showing up to hospitals both younger and more seriously ill than during the first two waves of the pandemic in Ontario.
The good news, according to Stall, is that the once-raging fire in long-term care has been nearly extinguished. But he warned younger, unvaccinated adults remain at risk of falling ill.
“There are a lot of susceptible individuals,” he said.
Ontario boosting hospital capacity
Stall said the analysis should be sobering, for both decision-makers in the Ontario government and the public — though he acknowledged the mixture of pandemic fatigue and vaccine euphoria facing many residents may make it hard to comprehend what’s in store in the weeks ahead.
So will Ontario follow B.C.’s lead and implement a large-scale lockdown? Or a stay-at-home order like the province was under after cases kept spiking following the heightened restrictions put in place last December?
Alexandra Hilkene, a spokesperson for the Ministry of Health, said health officials will continue to “review the data and trends” but did not share any plans for future restrictions.
She also noted the province’s hospital investments, including up to $125 million to expand critical care capacity. Work is happening to add over 500 critical care and high intensity medicine beds to hospitals in areas with high rates of transmission, she said, plus two potential field hospitals, one that could be available in early April at Sunnybrook Health Sciences Centre in Toronto, with early site work happening in Hamilton as well.
“Ontario Health and the Ontario Critical Care COVID Command Table continue to work with our hospitals to transfer patients from hospitals who are at capacity to other sites to ensure no capacity goes untapped,” she continued.
Experts who are ringing alarms warn boosting capacity and shuffling patients around won’t stop people from falling ill in the first place.
“We should not hope for miracles,” Juni said. “They’re not coming … vaccines will work much better when we start to control the growth we have now, otherwise the force of infection will be too high.”
‘Significant delays’ until impact is clear
According to the briefing note, “there will be significant delays until the full burden to the health-care system becomes apparent,” because the increased risk of COVID-19 hospitalization, ICU admission and death after infection is most pronounced 14 to 28 days after diagnosis.
Other non-COVID-19 procedures and appointments could be delayed, Stall noted, adding to a sky-high backlog that’s been prompting concerns over delayed treatments and missed diagnoses for the last year.
Now, much of what’s to come is already set-in-stone, Juni warned. But he stressed a light at the end of the tunnel does remain — and there’s still a chance to prevent future deaths through a combination of policy and individual action.
For the government, he said, that should mean a complete lockdown of all indoor spaces, given the higher transmission risk. For Ontarians, he stressed the need for strict adherence to public health precautions while relying on the warming weather to spend time outside, where the risks of getting infected are lower.
“It’s important now that everybody just wakes up and comes out of denial,” Juni said.