The Ontario government is scrambling to remake its COVID-19 response plan after reversing new lockdown measures in the face of unprecedented civil pushback and pleas from the province’s science advisers to adopt their recommendations as the health care system buckles under the impact of growing case counts.
Late Sunday, the government said it would begin offering the AstraZeneca vaccine to anyone 40 and older this week, lowering the previous age threshold of 55. The news may help accelerate the province’s vaccination campaign, which had been criticized for being too slow to roll out and insufficiently targeted at communities where the disease is spreading fastest.
The broadening of vaccine eligibility comes after a weekend of fierce criticism of the Ontario government. Last Friday, Premier Doug Ford announced a raft of policies to contain rising case counts. The Premier’s moves included more restrictions on outdoor activities and increased powers for police to stop and question people outside their homes.
The measures were condemned by many experts as misguided, led to an outpouring of anger on social media and prompted police in many jurisdictions, including Toronto, to declare they wouldn’t stop people randomly. The government lifted some of the restrictions on the weekend, allowing playgrounds to reopen, for example, and backtracked on the police powers, but kept a lid on many other outdoor activities.
Members of the Ontario COVID-19 Science Advisory Table said there are three policies that Mr. Ford could enact immediately that would save lives: the increased redirection of vaccines to COVID-19 hot spots, particularly in the Greater Toronto Area; the provision of paid sick days; and a narrower definition of an essential business
The Globe and Mail spoke with more than half a dozen members of the advisory table during the weekend and all expressed dismay with the government’s actions. Several say they considered resigning in protest, but feared the move would only worsen the government’s next steps.
Peter Juni, the scientific director of the table, said he was “at a loss” trying to understand why the provincial government announced a suite of measures that didn’t account for his group’s advice.
Nathan Stall, a physician and the assistant scientific director of the table’s secretariat, said he was dumbfounded by the government’s rejection of science and common sense.
Andrew Morris, an infectious-disease specialist and also a member of the table, said his reaction Friday was a mixture of shock, disbelief, anger and sadness.
Alison Thompson, a member of the Ontario COVID-19 Health System Response Bioethics Table, another group advising the Ford government, said she and her colleagues were stunned, especially by the absence of enhanced protections for essential workers.
“It was probably one of the lowest points in my career. It was hard not to quit,” Dr. Thompson said.
Dr. Morris added the government’s small steps to correct themselves during the weekend shouldn’t distract from their failure to implement the policies that could alleviate the crisis.
“We need a government that will listen to science,” Dr. Morris said.
Behavioural scientist Laura Desveaux, a member of the science table, said she felt angry and deflated to learn of the measures on Friday.
“I started to reflect on what were the restrictions that were announced and, benefit of the doubt, how could that link back to the evidence that was presented? And some of it clearly didn’t,” she said.
On Saturday, when the province reversed course on two of the new restrictions – the sweeping new police powers and the closing of playgrounds – her anger began to wane. She was pleased with the course correction, which she called responsive policy.
Before Ontario Health Minister Christine Elliott announced Sunday night that the province would drop the age limit for the AstraZeneca vaccine to 40 at pharmacies and doctors’ offices, Dr. Juni said it made sense to lower the age in Ontario, where the coronavirus is rampant.
“We need to have an open mind,” he said. “We need to be aware that this age cutoff of 55 is sort of an arbitrary cutoff to find this balance between potential rare side effects – remember it’s rare, we’re talking probably a frequency of one in 100,000 – and the risk associated with COVID. The more the risk of being infected with COVID goes up, the more this age cutoff should move down.”
Ontario reported more than 4,000 new cases on Sunday and Monday, and the table’s new modelling released last week projected the third wave could crest to more than 10,000 new daily cases by the end of June, with up to 2,000 patients requiring intensive care by mid-May – more than double the current amount.
Dr. Juni said after Friday’s announcement he and his colleagues asked themselves whether they could have been clearer with the government and concluded the problem was not on their side. He considered resigning, he said, but ultimately decided to continue the work.
“I believe there are still members of the table who are seriously considering stepping down,” he added. “This is a volunteer table. People are independent and they need to do what they feel is right for them. I believe the majority of the table will stay on. We’re not doing that for the government, we’re doing that for the people of this province.”
Dr. Juni said condo construction needs to pause, office jobs that can be done from home must be, and the list of goods whose production is deemed essential should be slimmed down.
He also reiterated outdoors is far safer than indoors, and urged the government to make it easier for people to get outside, especially those who live in overcrowded housing in hot-spot neighbourhoods.
The Ford government’s move to ban nearly all outdoor recreation on Friday only deepened the inequities that have been laid bare by the pandemic, Dr. Juni said.
“It just increased the distinction between those living in a house with a garden and the rest of the population living in a flat or in a condo. What we really need to do is make sure outdoor spaces are used as much as possible and, of course, as safely as possible.”
Fahad Razak, an internal medicine physician at St. Michael’s Hospital and another member of the science table, said the group was deeply disappointed by the measures as announced on Friday.
“It was very striking to see the disconnect between what we believe the best science had shown and what the policy that had been rolled out was,” he said. “Especially for my colleagues in [hard-hit] community hospitals in Brampton, in [the William Osler Health System], they were just devastated. You could hear it in their voices.”
The federal government on Sunday stepped in with an offer to cover the travel costs of nurses and doctors from other provinces who are willing to help Ontario manage a surge in serious cases of COVID-19.
Prime Minister Justin Trudeau announced the plan and other measures in a video posted to social media on Sunday afternoon.
The government of Ontario, meanwhile, said it was contacting foreign consulates to ask them to provide the province with vaccines.
“Ontario has the capacity to vaccinate more people, but we are lacking the supply to do it,” said Ivana Yelich, a spokeswoman for the Premier.
Ottawa is also offering to provide federal public servants, who could help provincial officials in areas such as contact tracing.
Mr. Trudeau said he and his ministers have been in touch with other provincial and territorial ministers to determine how they may be able to help Ontario.
“We are mobilizing federal health care workers from across government departments to deploy to the front lines in Ontario – and specifically the GTA – where the situation is most critical,” he said. “There are provinces that have managed their health care capacity for their own local situation and have the ability to lend a hand to others.”
The federal government’s Sunday announcement includes $84.2-million for voluntary safe isolation sites in Ontario and $46-million to boost the province’s virtual health care services.
Federal ministers said Canadian Armed Forces aircraft are available to transport provincial staff and supplies to Ontario. The ministers did not say whether any provinces have agreed to share some of their allotted vaccines with Ontario.
Allison Furey, a physician who is married to Newfoundland and Labrador Premier Andrew Furey, is among the provincial doctors who are ready to travel to Ontario, according to federal Intergovernmental Affairs Minister Dominic LeBlanc.
Dr. Morris, on Ontario’s table, said the provincial government needs to redirect its vaccine strategy to the communities where the virus is spreading fastest, and that means regions of the GTA where residents work in precarious jobs that require face-to-face contact, live in multigenerational homes and in settings where it’s hard to isolate.
“There are places in the province that have just as much per capita vaccine as [hot spots] Peel and Scarborough and Durham and York Region. We need to change that,” Dr. Morris said.
Dr. Stall said paid sick leave, which has been a top recommendation for months, seems to have become a political hot-button, but it need not be.
“This is not about politics anymore,” Dr. Stall said. “If you walk inside a hospital or an intensive-care unit, or you’re a patient or a front-line worker, you know things are definitely not normal right now. It’s not just the number of sick and dying patients in our hospitals, it’s all the collateral damage going on within our health care system.”
Dr. Morris said the next few weeks are going to be “brutal” as the number of patients requiring intensive care strains the system’s capacity. Toronto’s Sunnybrook Health Sciences Centre will this week begin treating patients in a field hospital set up to cope with the soaring need for beds.
“I think you’re going to see the system over all start to buckle,” Dr. Morris said. “Eighteen months ago, we talked about hallway medicine. Now we’re talking about hallway deaths and tent deaths, because we don’t have the nursing capacity, the physician capacity, the ventilator and medication capacity, for what we’re facing.”
With reports from Laura Stone and Andrea Woo
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