Just over a week into the reopening of Ontario’s economy after months of lockdown over COVID-19, there is an eagerness to see if the moves made were the right ones.
The answer, however, is not a straightforward one, nor is it on the immediate horizon, experts say.
“It’s unsatisfying in that we have to wait and see,” said Ashleigh Tuite, an infectious disease epidemiologist and researcher with the University of Toronto.
“The challenge is, the province’s reopening plan doesn’t exist in a vacuum.”
On Monday, Ontario reported more than 400 new COVID-19 cases for a fifth straight day. However, the streak was broken Tuesday, as the province recorded 287 new cases, the lowest number since the end of March. That brings the total in the province to 26,191 cases, including 2,123 deaths.
The reason for the upward trend is hard to definitively pinpoint, Tuite said. While the provincial health minister attributed the consecutive uptick to Mother’s Day weekend — “people seeing families when they should not have been more than five people together” — there are underlying influences, according to Tuite.
“There’s a behavioural component,” she said. “Having businesses open up in a safe way is relatively low risk. The bigger concern is the messaging around what this means for individuals and what they should be doing right now.”
Ontarians have been instructed to avoid being within two metres of anyone outside their household and to not gather in groups larger than five. The public safety recommendations still stand as well: maintain physical distancing, wash your hands regularly, wear a mask while in public places and stay home if you’re sick.
This month, the Ford government took its first steps to reopen the province. As of May 19, retail shops outside of shopping malls could reopen, along with golf courses, marinas, pet groomers and libraries for pickup only. Certain health and medical services, recreational activities and household services were also given the green light to resume. All must abide by physical-distancing and public health guidelines.
It’s the first in what officials have said will be a slow and cautious reboot while the virus still lingers in the province.
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So how will we know if the phased plan is working or not?
The numbers will be our first sign, but we need to look at the right numbers, said Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto.
“It takes many weeks to see the effects. It’s like an interest rate change in the economy. It takes time to figure out whether that was too little or too much,” he said.
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While Furness believes the province started opening too soon, he said the day-to-day case numbers aren’t what to watch for.
“That’s a bit like chasing our tails,” he said. “We need to look at the longer trend. To know if we opened too soon, the multi-week view will reinforce that. The numbers we see now won’t tell you that yet.”
Reopening and boosted testing
The reopening steps started within days of the province attempting to boost low testing numbers. Premier Doug Ford announced Sunday that testing would open to everyone — symptomatic or not.
The two will be hard to separate as we go forward and analyze what causes cases to either grow or shrink in Ontario, said Tuite.
“We can’t easily disentangle them. That’s always going to be the challenge when you have a lot of moving parts, you’re changing testing strategy, you’re changing public health response. And a little bit of this is life, reality and messiness we have to deal with,” Tuite said.
As the weather improves, sheer human behaviour coupled with changing public health and government messaging might also be to blame, she added, which will be harder to quantify.
“Ideally, you would have staggered them so you could actually monitor what’s happened, what the effect of reopening has specifically been on cases. Now we’re in a situation where we’re relying a little bit more on more severe outcomes to give us a better sense of what’s happening.”
There are a number of metrics that will help paint a better picture of the impacts of the plan, said Isaac Bogoch, infectious disease specialist at Toronto General Hospital, but the number of hospitalizations and intensive care patients will be a key one.
“Even then, there’s a lag time of about two to three weeks for those to show up,” he said. “You really have to use all these metrics together to get a holistic picture of what’s happening in a particular region.”
Ford has said mass testing is the province’s best defence against the virus as the province reopens and that a new strategy targeting specific sectors will be announced in the coming days.
That’s the logical next step now that businesses have opened their doors and people are leaving their homes more, according to Furness. He said it should be ramped up even further with sentinel testing, which targets asymptomatic virus carriers with “major occupational exposure,” like grocery store workers, taxi drivers and transit operators.
“Assessment centres might give anyone a test, but you’re still relying on people to actually process this and show up,” he said. “You don’t just change the criteria and sit back and wait. We need to actually proactively go out and test people where the risk is.”
Contact tracing will also be crucial for this, Bogoch added.
The province is looking into boosting its contact tracing efforts as it eyes loosening more restrictions to reboot the economy. Ford has said he supports a national, co-ordinated approach. Recently, he signalled that the province would join a nationwide smartphone app program to help trace contacts of positive cases, should the Trudeau government endorse one.
Federal contact tracers are already helping public health authorities do so in Ontario — more than 200 of them are helping trace contacts of positive cases.
Now that testing has broadened its criteria and the economy is getting its first sign of life, contact tracing is our next buffer, said Bogoch. Especially as we see “upsetting” rising numbers in Ontario over the past few days, he said.
“It’s the contact tracing that answers the next questions: who was infected? Where did they get it? Who were they in touch with?” he said.
“Now that we have some things open, we want to identify an outbreak quickly before it spirals out of control.”
— With files from the Canadian Press and Global News’ Maryam Shah
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