Toronto and surrounding areas should find out sooner than expected if they can join the rest of the province in Stage 3 reopenings.
Today’s Stage 3 reopenings for 24 of the province’s 34 public health units allows restaurants to resume indoor service and bars, gyms and theatres to throw open their doors again. Limits on indoor gatherings have been lifted to a maximum of 50 people while as many as 100 people are allowed to congregate outdoors.
The Toronto and Hamilton areas, Niagara region and Windsor-Essex have been excluded from the reopenings, which were announced earlier this week.
Eileen de Villa, Medical Officer of Health for Toronto, says the city may be ready to move forward sooner than expected, citing two out of four green lights for the GTA to move on to Stage 3. An average of 41 new cases found daily in Toronto and slow turnaround on new COVID-19 tests have held “Virus Spread & Containment” and “Laboratory Testing” markers at yellow, while the overall “Health System Capacity” (adequate numbers of personal protective equipment, as well as low bed and ventilator occupancy rates) and “Public Health Capacity” (98.4 per cent of new cases contacted within 24 hours) markers have turned green.
Premier Doug Ford called Stage 3 “an important step in getting back to normal” in his press conference announcing the reopenings earlier this week, emphasizing the need for small businesses to get back on their feet following pandemic closures. He assured reporters that the province was not rushing blindly into reopening.
Dr. Sumontra Chakrabarti, an infectious disease specialist with Trillium Health Partners, echoed the sentiment, saying that while some parts of Ontario are still transmission hotspots, keeping places like Thunder Bay — which currently has only one active case of the virus — under lockdown is unnecessary.
However, the wave of reopenings has unnerved Dr. Jeff Kwong, leader of the Populations and Public Health Research Program at ICES. Kwong says something that hasn’t been discussed is restriction of travel between regions, which could bring the virus into low-transmission communities.
“If people are travelling to go to a bar, for example, you can bring cases from one area to another,” says Kwong. Groups of people intoxicated, indoors, in sometimes poorly ventilated areas, shouting to be heard over loud music seem like ideal conditions for transmission, he says. “In so many places around the world, reopening has been associated with outbreaks.”
Chakrabarti agrees that bars and restaurants are higher risk but he says that the methods for reducing risk are simple and effective enough to justify reopening.
“If you do it the right way,” he says, “take away certain things like a dance floor, have a maximum occupancy with the caveat with the spread-out seats, have a table max, it’s reasonable to try it.”
“In the phase of the outbreak that we’re at now, it is expected that we’re going to be seeing small clusters of cases pop up. That shouldn’t be looked upon as a failure, that’s a success as long as we’re able to track it, trace it, and then deal with it.”
Kwong says the situation will have to be monitored carefully. “Having the capacity to test so that people who develop symptoms can get tested as soon as possible, doing contact tracing so we can control outbreaks as soon as possible” is vital to controlling this stage of the outbreak. Kwong cites the recent outbreak stemming from two Kingston nail salons as an example of what should be expected in Stage 3. While Kingston saw a sharp spike in cases following that incident, fast and aggressive testing kept the spread under control.
De Villa has said that Ontario has seen improvements in the speed with which new cases are reported. The province and infectious disease specialists will be closely monitoring any small outbreaks, tracing where they come from, and getting a better picture of what is and isn’t high-risk.
Finance Minister Rod Phillips has warned that “choosing to act responsibly and respectfully is more important than ever to avoid taking a step backwards.”
A willingness to return to Stage 2, however, is an integral part of the success of Stage 3, according to Chakrabarti.
“It’s a test to see the overall picture of COVID-19. I completely understand the apprehension. Going into Stage 3, we’re going to be monitoring closely, and if we begin to see an uncontrollable increase in cases, then we’re going to pull back,” says Chakrabarti.
Kwong warns that outbreaks are inevitable. “It’s almost certain that we are going to see some outbreaks associated with these settings,” he says. “It’s a question of how many we’re going to see, how much tolerance we’re going to have for these incidents, and how directly that will lead to the reversal of this relaxation.”
One of the main goals of Stage 3, according to de Villa, is to learn more about the virus and committed to passing that understanding on to the public in regular updates.
“Work is underway on a deeper data analysis to help us understand patterns and trends and what has changed over the course of this pandemic in our city,” says de Villa. That data is then being used to:
- Inform testing for Toronto’s homeless population;
- Inform where to move mobile testing clinics;
- Create guidance documents for businesses, community services, and school boards; and
- Inform public health messaging
“Going into Stage 3, we’re going back to some semblance of normalcy,” says Chakrabarti.
That sense of normalcy has encouraged the National Hockey League to declare Toronto one of its hub cities, and has allowed CampTO to launch its 2,500-person summer camp programs.
“Just being able to see your friends, go to a restaurant, go to a pub, have a drink, these kinds of things are all good for morale,” says Chakrabarti.
These, said de Villa, “are important steps that help build our community as we continue moving forward with getting our city back.”
David Williams, Ontario’s Chief Medical Officer of Health, has said he hopes to see all of Ontario enter Stage 3 by the end of July.