Is Ontario's regional staged approach working amid the province's second wave of COVID-19?

Jumpradio.ca
October 23, 2020

As Ontario continues into the second wave of the COVID-19 pandemic, several regions -- including Toronto, Ottawa, Peel and York -- have moved back to the province’s modified Stage 2 of its reopening strategy.

The decision has forced many businesses in those regions -- most notably indoor dining and gyms -- to close for the second time this year as the pandemic continues to affect millions of Ontarians.

While some regions have regressed back to Ontario’s modified Stage 2, many areas neighbouring those regions are still in Stage 3, which allows gyms, indoor dining, cinemas and other businesses to remain open with restrictions.

But because of Ontario’s geography, it’s not difficult for people living in high-transmission areas, like Toronto or Peel, to travel to nearby communities, like Durham or Simcoe County, whether it’s for work or leisure.

This has led to concerns among some Ontarians who live in low-transmission areas that are still in Stage 3. They are worried that people may come to their communities from COVID-19 hot spots to utilize the services that are open there.

Right now, the Ontario government recommends people across the province to limit trips outside their household for essential purposes only. The government is also encouraging residents to limit their travel to other regions in the province, especially between high-transmission areas and low-transmission ones.

Concerns of regional travelers

Barrie, Ont., Mayor Jeff Lehman told Global News he’s watching the situation closely since there’s potential for his city, and others like Kitchener-Waterloo and Guelph, to see “economic tourism,” where people are attending businesses that are open in Stage 3 regions that are closed in other hotspot ones.

“I certainly heard that concern from people in our community,” he said. “I did check in with our downtown merchants’ association to see what they were hearing from the restaurant sector here. They are not hearing a lot of concern about that.”

Lehman said local restaurants see some out-of-town visitors but that there hasn’t been large lineups or crowds.

“The reality is if we don’t limit non-essential trips, then we are going to see further spread of the virus,” he said

Northeast of Barrie lies Georgina, Ont., which is part of York Region. The town only has two active cases of the novel coronavirus but has been forced to move back to Stage 2, along with the rest of the municipality.

“The reality is in our region, people travel every day to go to work in Vaughan, to go to work in Toronto, to visit family in Richmond Hill, Simcoe County,” Georgina Mayor Margaret Quirk said.

“The province has deemed that it’s a regional approach. Would I like them to take a second look at it? Sure.”

The other side of the coin, she said, concerns areas that aren’t part of the modified Stage 2 becoming destinations for people who are residents of Stage 2 regions.

“We saw that happening in the Toronto-area crossing because it’s a line on a map,” Quirk said. “One side of the road is open, the other side is closed. Of course you’re going to cross the street to go to the restaurant that still lets you sit inside.”

Despite the province’s travel recommendations, some businesses have taken matters into their own hands to further limit out-of-town visitors.

On Wednesday, the Town of New Tecumseth banned people from regions that are under modified Stage 2 of the province’s reopening strategy from using its recreation centres. Last week, The Canadian Press reported that some restaurants in southern Ontario have started banning out-of-town customers from indoor dining.

Is Ontario’s regional staged approach appropriate for the 2nd wave?
While there are challenges to the province’s regional reopening strategy, experts say a regional or localized approach is fair when it comes to responding to the COVID-19 crisis during the second wave.

“Just as a general principle, public health works best when it’s conceived and implemented locally,” said Dr. Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto’s faculty of information.

“Every public health unit has its own population, its own characteristics. It knows what it needs. It knows where the risks are.”

According to Furness, it doesn’t make sense to enforce blanket rules across the province from a public health perspective, and Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital, agrees, saying it’s not fair to have a one-size-fits-all solution.

“I think this staged, regional approach really allows (for) more granularity in policy,” Bogoch said. “It probably has better health and economic outcomes because you’re not imposing uniform restrictions across a population of nearly 15 million, where only a fraction of them are in areas where COVID-19 is spreading at high levels.”

However, Furness believes Ontario needs more than three reopening stages that reflect the diverse needs and situations of regions across the province.

“This concept of modified Stage 2, it doesn’t sit well with me because it doesn’t convey clearly what we need,” Furness said. “The closing of indoor dining and bars and gyms (is) absolutely essential, absolutely vital. That’s an example of something that actually could and should have been done across the entire province.”

In an email to Global News Thursday, Alexandra Hilkene, the Ontario health minister’s press secretary, said local medical officers may introduce additional public health measures and restrictions through the use of Section 22 under the Health Protection and Promotion Act.

“We support these decisions being made based on local need,” she wrote.

Confusion over public health guidance, messaging

Some people in Ontario have expressed confusion over the province’s recent public health guidance and restrictions, particularly when it comes to celebrating Halloween and the reopening of dance studios in COVID-19 hot spots.

“It’s confusing that some fitness activities are being permitted and others are not, and that’s creating some frustration with some of the local gym operators,” Quirk said of Georgina.

“I wish there was some more clarity as to why certain things can happen and other things can’t.”

In an email, Hilkene said dance programs are permitted in the same way that “comparable activities” for sport and recreation -- like gymnastics and cheerleading -- are allowed, subject to public health and workplace safety measures.

“In these programs, individuals must register for a multi-week or year-long program with the same small group of participants in the class week after week,” Hilkene wrote. “Dance programs would be required to comply with several measures.”

For Mayor Lehman, it can be confusing when the same public health guidance is described in different ways by officials. He said his own organization sometimes struggles to remain consistent with Ontario public health, local public health and the federal government, as well as surrounding municipalities.

“We all try and have consistent messages, but it can be difficult and confusing,” he said.

Bogoch said he agrees there could be more clear messaging, directives and better coordination between government, public health and political leaders but that he also believes there needs to be tolerance for the fact that everyone is going through a pandemic for the first time.

“Everyone is trying their best,” he said.

Furness, however, said public health is best done by establishing what’s safe by getting social norms to dictate behaviour -- not enforcement. One example is the use of condoms, he said, which isn’t enforced but has become a social norm when seeking out a new sexual partner.

“When you do it by enforcement, you just get people to kind of go more underground, and that’s problematic,” he said.

“I think the problem is not that Ontarians can’t keep their minds on this for more than a couple months. I think it’s just people are confronting rules that are completely inconsistent and incoherent, and that’s just making people exasperated and exhausted.”

In order to fix the issue, Furness said Ontario needs a public health leader.

“We don’t have one. We have a chief medical officer of health who’s occupying the office and he’s causing a great deal of harm,” he said. “He needs to go, and he needs to go immediately.”

Furness isn’t the only one to call for the departure of Ontario’s Chief Medical Officer of Health Dr. David Williams. Others in the medical community have also called for him to leave his post as Ontario’s chief medical officer.

Read more:
Coronavirus: Ford defends Ontario’s top doctor in wake of calls for him to step down

Ontario Premier Doug Ford has continued to defend Williams, saying he’ll keep relying on him.

“I don’t believe in changing the dance partner in the middle of the dance here,” Ford said on Oct. 9. “He’s been phenomenal.”

In response to concerns over confusing public health communication in Ontario, Hilkene said Ford is the “only premier” in Canada who continues to hold daily press conferences about COVID-19.

“In addition, Dr. David Williams and Dr. Barbara Yaffe continue to update the public every single week,” Hilkene wrote.

“This is on top of the broad-based advertising campaign across multiple media: television, radio, Facebook, Twitter, Instagram, Snapchat, among others.”