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Ontario's Chief Medical Officer of Health Dr. David Williams, seen here on March 25, 2020 told reporters that some orders had already been issued against people skirting isolation rules, and that the move was a warning ‘that this is not a casual thing, this is a serious issue.'

Frank Gunn/The Canadian Press

Ontario’s top public health official is urging local authorities to issue fines of up to $5,000 a day for COVID-19-positive people and any close contacts who skip out of self-isolation, saying some have been flouting recommendations to stay put.

The directive came as the province’s Premier, Doug Ford, warned on Wednesday that Ontario risked the fate of Italy and Spain, where the virus has overwhelmed hospitals and deaths have skyrocketed. He also said decisions on whether more businesses would be deemed non-essential and added to the list of those closed was coming in days.

“My friends, the hard truth is, right now, today, there is very little separating what we will face here in Ontario from the devastation we’ve seen in Italy and Spain,” Mr. Ford said. “Thousands of lives are at stake.”

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As the number of cases tallied by the province continued to rise, increasing by 426 to hit 2,392, with 37 confirmed deaths, David Williams, Ontario’s Chief Medical Officer of Health, issued a memo to local medical officers of health on Wednesday. He recommended they use their powers under the Health Protection and Promotion Act to issue formal orders and fines if needed to keep people who have tested positive for COVID-19 and their close contacts in isolation for 14 days.

Dr. Williams told reporters that some orders had already been issued against people skirting isolation rules, and that the move was a warning “that this is not a casual thing, this is a serious issue.”

Meanwhile, Toronto’s Medical Officer of Health, Eileen de Villa, announced Wednesday she was going a step further. She said she was using her powers under the act to issue new mandatory “class orders” aimed at keeping all people in the city with COVID-19, and those suspected of having it or of having close contact with a confirmed case, in self-isolation for 14 days. Anyone caught defying this kind of order could see immediate fines of up to $5,000 a day, city officials said.

(A federal order already requires those who have travelled outside the country to stay in 14-day self-isolation, with violators risking fines of up to $1-million.)

Expressing deep concern at the steep increase in cases in her city, Dr. de Villa warned that restrictions on gatherings and physical distancing – staying inside as much as possible, keeping two metres apart when in public – would be in place for at least 12 weeks. On Tuesday, Mayor John Tory had announced that all city events, including its large Pride parade, were cancelled through to the end of June.

The mayor warned Wednesday that if Torontonians loosen their resolve and start to gather in groups as the spring weather improves, physical distancing and widespread shutdowns could remain in place for even longer.

In addition to Dr. de Villa’s new enforcement measures, Mr. Tory also said he had a bylaw drafted that would impose fines on any resident caught defying physical distancing rules, but has not decided to implement it yet. In nearby suburban Brampton, Ont., Mayor Patrick Brown has already brought in a similar bylaw.

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Dr. de Villa said she was now using her maximum powers under current laws, and Mr. Tory said the latest measures were “locking the city as much as any municipal government could.”

Toronto’s COVID-19 cases increased by 500 per cent in just two weeks, Dr. de Villa, said, also warning that the city could face the same fate as Italy, Spain or New York. Toronto said in a statement that as of March 31, it had 763 cases of COVID-19, with 66 in hospital, 33 in intensive care and eight deaths.

Dr. de Villa also said she was advocating for the province to narrow its list of essential businesses allowed to remain open, but did not provide specifics. Opposition NDP Leader Andrea Horwath wrote to Mr. Ford on Wednesday to say that he should shut down all but essential construction sites.

Mr. Ford defended leaving construction sites open, saying provincial inspectors were out in force and would not hesitate to shut down sites deemed unsafe. But he said a revised list of what was deemed essential and allowed to remain open could be issued in days.

“That’s being reviewed every day," Mr. Ford said. "We’re going to be adjusting that list. You’ll hear that in the next day or so.”

The Premier would not discuss the details of any modelling showing death-count projections of the kind unveiled in the United States this week, saying an overestimate could cause panic. Dr. Williams said the province needs more data before it is confident in any such projections, but said he would release an estimate next week.

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A 93-bed temporary pandemic response unit is being assembled at the Joseph Brant Hospital in Burlington, Ontario. The unit should be ready for COVID-19 patients in about two weeks. The Globe and Mail

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