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A man exits a COVID-19 Assesment Centre in Toronto, on Dec. 18, 2020.Frank Gunn/The Canadian Press

Canada’s Chief Public Health Officer, Theresa Tam, is warning the COVID-19 epidemic curve in many parts of the country is not bending, and provinces such as Ontario “will have to evaluate their measures.”

“I believe that in many areas of the country, stricter measures should be put in place as soon as possible,” she said on Friday as the case counts worsened across Canada.

Ontario promised to reveal on Monday whether it will impose any sweeping or stricter lockdown measures beyond what it has already announced, while Quebec started to prep hotels to deal with overflow from hospitals.

On Friday, Ontario extended current lockdowns in Toronto and Peel Region, which includes the cities of Brampton and Mississauga, until at least Jan. 4, and said Hamilton will go into lockdown on Monday.

Premier Doug Ford, who held an emergency meeting with hospital leaders on Friday, said his cabinet will determine over the weekend whether to announce even stricter measures on Monday. Lockdowns currently permit essential businesses to remain open at 50 per cent capacity, and include big box retailers.

The new measures being debated include broader lockdowns and an extended school holiday break, with the mayors of Mississauga and Toronto calling for tougher measures across the entire Greater Toronto Area. Windsor-Essex and York Region went into lockdown last week, and the province tightened restrictions for a total of five regions on Friday.

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“The trends we’re seeing throughout Ontario are very, very concerning,” Mr. Ford said on Friday.

Dr. Tam said the most troubling indicators are the hospitalization and intensive care occupancies, because they reflect what happened at least two weeks ago. “I think every chief medical officer is a bit anxious about the holiday period because naturally people want to get together and people want to go shopping, and so now is not the time to go and get into crowded malls or shops,” she said.

The Ontario Hospital Association (OHA) this week called for more regions to be locked down and for even stricter restrictions in lockdown zones to be considered. After the hospital leaders met with Mr. Ford and Health Minister Christine Elliott on Friday, the OHA said it is “hopeful” the government will heed its advice to implement “stricter and more robustly enforced public health measures in communities across Ontario.”

Ontario’s small business community said the renewed lockdowns sound the death knell for retailers. “To lose the entirety of the holiday season is a crushing blow, and, unfortunately, will be the final one for many of them,” said Ryan Mallough, director of provincial affairs for Ontario at the Canadian Federation of Independent Business.

Doctors say a lack of data about outbreaks, particularly in Toronto, is concerning. In Toronto, the sources of 70 per cent of cases now cannot be traced, according to recent provincial modelling. However, Toronto Public Health said that number is not correct because of a “coding issue” on the source of exposure data at the provincial level, and the number is actually 12 per cent for the week of Dec. 1 to 7. A spokesperson for Health Minister Christine Elliott said the ministry is working with Public Health Ontario and others “to look into the issue and ensure it is resolved.”

Public Health Ontario clarified Sunday that the coding issue is that the 70 per cent combines cases with no known epidemiological link and cases with no information whatsoever.

“It’s a huge problem. How are you supposed to mount an effective response when you don’t know upstream where a vast majority of your cases are coming from?” said Isaac Bogoch, an infectious diseases physician, adding that some regions have a far better understanding than others.

Schools have also become a flashpoint in the debate, with data from Ontario’s asymptomatic testing program in Toronto, York, Peel and Ottawa showing a small number of coronavirus cases have been found in schools. Of 3,654 tests completed, only 57 positive cases were found, with another 890 results pending.

“While schools may be responsible for some transmission, I don’t think it’s fair to say that schools are driving the epidemic at this point,” Dr. Bogoch said.

Since the start of the second wave, test and tracing regimes in the hardest-hit provinces like Alberta, Ontario and Quebec were curtailed after becoming overloaded. Data on the location of outbreaks, which were limited to start, became even less reliable.

“We don’t really know where a lot of cases are happening,” said Kirsten Fiest, an epidemiologist at the University of Calgary. “Our contact tracing has completely collapsed in Alberta.”

Quebec is again preparing to put hospital beds in hotel rooms as the steady climb in the number of people in hospital with COVID-19 broke past 1,000 and the health minister on Friday declared 10 medical centres to be in a critical state.

“The situation is very critical in hospitals,” Quebec Health Minister Christian Dubé said. “In some of the 10 locations, we are preparing beds in non-traditional sites.”

Quebec has 2,164 COVID-19 beds. The major hospitals in Sherbrooke, Saguenay, Trois-Rivières and Gatineau are at a critical stage. In Montreal, two hospitals are nearly full, while the other major medical centres in the city still have available beds.

“Some regions are hit harder than others, but it’s also about trends,” Mr. Dubé said. ”A month ago, we had 500 beds with COVID-19 patients, we now have 1,000. Every time we fill a COVID-19 bed, there are other medical activities we can’t do. We don’t want to get to the worst-case scenario.”

Quebec will shut down non-essential retail from Christmas until Jan. 11, and has ordered anyone who can work from home to do so. The primary school Christmas vacation will extend an extra week, to Jan. 11, joining high schools, which were already doing distance learning until then. Restaurants, bars and most entertainment, recreation and social gatherings have been banned since Oct. 1.

The initial COVID-19 vaccinations in Canada and around the world raise questions about how people react to the shot, how pregnant women should approach it and how far away herd immunity may be. Globe health reporter Kelly Grant and science reporter Ivan Semeniuk discuss the answers.

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