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Up until the last few days, Ontario - Premier Doug Ford seen here with Minister of Health Christine Elliott and Ontario Chief Medical Officer of Health Dr. David Williams on March 16, 2020 - posted daily updates online detailing pertinent details of each new COVID-19 case in the province, including how the person caught the infection.

Frank Gunn/The Canadian Press

Ontario health officials are no longer releasing information about how most people infected with COVID-19 caught the disease, an example of what some experts describe as a growing transparency problem that risks undermining public trust in the health-care system.

Up until the last few days, Ontario posted daily updates online detailing pertinent details of each new COVID-19 case in the province, including how the person caught the infection. Most of the identified cases have been travel-related, with people testing positive after returning from places such as China, Iran, Italy and the U.S. But increasingly, that information is missing, meaning there’s no way to know how dozens of people in Ontario contracted the virus – and whether it’s spreading in communities.

By contrast, Alberta health officials announced Saturday that two positive COVID-19 cases were possibly linked to community spread. The next day, it confirmed the two cases were likely instances unrelated to travel and as a result, closed schools and child-care facilities, and further tightened rules prohibiting mass gatherings. On March 6, B.C. Provincial Medical Health Officer Bonnie Henry said the province had identified its first case of community transmission.

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It’s a significant difference from Ontario’s approach and it has ramifications for how health-care workers and the public respond to the coronavirus outbreak.

Local spread means health workers must adopt new surveillance measures and the public needs to take extra precautions to guard against infection. It also means the virus is more difficult to contain and that social distancing is required to slow transmission, so timely information conveying this to the public is vital, said Michael Gardam, an infection control expert and chief of staff at Toronto’s Humber River Hospital.

“Almost certainly we have community spread,” Dr. Gardam said. “I think that’s an important message to get out because it’s going to help your social distancing measures. If people know it’s out there, they’re less likely to wander out to St. Patrick’s Day parties.”

Despite a spike in the number of cases in Ontario, to 189 on Tuesday from just 59 last Thursday, the province’s top health officials have avoided saying the virus is spreading locally. On Tuesday, officials said 92 per cent of the province’s cases are linked to international travel or to close contacts of people who travelled and tested positive for the virus. But David Williams, Ontario’s Chief Medical Officer of Health, said he can’t conclude the remaining 8 per cent are definitely linked to community spread. Before that can happen, health officials need to investigate every avenue to determine how or when the person became infected.

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“We’re still waiting to see actual examples of community spread,” he said during a briefing with reporters on Tuesday.

Barbara Yaffe, Ontario’s associate medical officer of health, said some of the information is missing about new positive cases, including how they caught the virus, because they are trying to post information as quickly as possible and don’t always have the investigations complete.

Jason Kindrachuk, assistant professor and Canada Research Chair in emerging viruses at the University of Manitoba, said the message contrasts sharply with what other health officials, even in Ontario, are saying. On Sunday, Ottawa’s medical officer of health, Vera Etches, said she believed it’s likely that hundreds of cases of COVID-19 are spreading in that community and urged people to avoid going out except for essential trips.

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Dr. Kindrachuk said he knows health officials must find a balance between informing and reassuring the public, but that it increasingly doesn’t make sense to avoid the recognition that COVID-19 is spreading locally.

“That may produce some fear in some people if they hear that,” Dr. Kindrachuk said. "[But] I think it’s important messaging to be getting out to people."

Regardless of the reason, a lack of transparency or contradictory messages between provinces risks confusing the public or leaving them unsure whom or what to trust, said Alison Thompson, an associate professor in the Leslie Dan faculty of pharmacy at the University of Toronto.

“Outbreak communications have a huge impact on the epidemic curve,” she said. “If they’re not communicating what the public needs to be doing in a consistent, understandable way, the public is less likely to comply."

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