About a week ago, one of Canada’s most-watched novel coronavirus charts — new infections in Ontario — started to head definitely, unmistakably, in the wrong direction.
Canada’s most populous province has endured one of the country’s stricter shutdowns, with schools now closed until September.
For much of May, it seemed to help tame the virus, with the line marching reassuringly downward. But recently, Ontario’s daily new cases have stayed above 400, with the curve showing no sign of the hoped-for flattening.
Ontario’s R number, the number of people who an infected person will, in turn, infect on average, has remained stubbornly over one, University of Toronto epidemiologist Ashleigh Tuite wrote in an email.
As our struggle with the pandemic has its advances and setbacks, victories and defeats, it’s unavoidable that restrictions will sometimes be tightened, warns Steven Hoffman of York University.
“All Canadians need to be ready for the need to reimpose layers of protection that are now being lifted in the event that we have an uptick in cases that represents a threat to our public health,” he says.
“We all hope to go back to the way things were before the outbreak started, but we need to be ready, and prepare for the likely scenario that some of these layers actually have to be reinstated.”
The R number is the main indicator that governments will look to as they decide whether or not to relax — or tighten — restrictions, Hoffman explains.
“There’s no magic number, but one helpful number to look at is the reproduction number,” he says. “A reproductive number of one means that the number of cases flatlines. That means that the infection continues, and people are still affected, but it’s not growing. That’s where you want to get to, or ideally, even better than that, a reproduction number below one. That means it’s petering out.
“The problem is that once it gets above one, we start to see exponential spread of the virus, and that can get us to a place like we were in the middle of March, where it was getting uncontrolled, and we needed some unprecedented measures to stop it in its tracks.”
With it, hopes for a further loosening of restrictions and a return to some version of normal, such as reopening daycares, seem to have faded for now.
On Saturday, thousands of people crowded Trinity Bellwoods Park in west-end Toronto, which the city’s chief medical officer of health condemned as “selfish and dangerous behaviour.”
But upticks in case numbers may happen for reasons that are out of our control, Hoffman says.
“Some of them might be our own fault,” he says. “If we lift too many layers of protection too quickly, then the existing cases we still have in Canada might end up further spreading and getting us to a place where we need to reimpose the extreme measures that we’ve been depending on up until now.”
But “even if we do everything right in Canada,” the virus could still make its way across the border, he says.
So it’s wisest to see it as inevitable.
“It’s not something we can fully control, even with the most robust measures at the border. This is something I think we just need to be ready for and be on guard for.”
The University of Toronto’s Vivek Goel expects new restrictions, if they end up being imposed, to be more precisely tailored to problem areas than the sweeping ones ordered in March.
“We are gathering more data as each week goes on, in terms of knowing which measures have what effects. That is because over time we have been imposing and then lifting different measures across jurisdictions,” Goel said.
“So instead of a strict reimposition of everything at once, as we have better information globally, if we start to see cases rise in a certain type of work setting, we might have constraints applied there and not necessarily across all of society.”
With a widely available vaccine possibly years away, and the population a very long way from herd immunity, we will have to figure out how to live with the virus for now as best we can, Goel says.
“At some point, the general public, and businesses, are going to have to really look at it from a societal perspective: how long can we continue to keep our society on life-support? That’s’ really what we’re doing.”
“The COVID-19 deaths are visible, and they’re on the news every night. But all these other deaths that are going to be taking place because people aren’t getting their cancer surgery, or kids are getting abused at home.”