Experts worry Ontario's new COVID-19 guidelines set threshold for closures, lockdown too high
New rules require 10% positivity rate before red level of restrictions imposed
One day after the province released its new colour-coded COVID-19 guidelines, doctors and other public health experts are expressing concern that the threshold for tightening restrictions in the hardest-hit areas is set too high.
In the new system, four public health units — Peel, York, Ottawa and Eastern Ontario — are set to be classified in the orange, or "restrict" category on Nov. 7 after moving out of the modified Stage 2. The same will happen in Toronto a week later, on Nov. 14.
Under the new orange category, businesses that had been closed or more tightly restricted under the modified Stage 2 rules will have those limits relaxed. For example, gyms will be able to reopen and bars and restaurants will be able to serve customers indoors with certain restrictions.
For them to be shut down again, and for a public health unit to be moved to the red, or "control" level, the area's positivity rate (sometimes also called "per cent positivity") would need to be above 9.9 per cent. The province would also look at factors like hospital and contact tracing capacity.
"Ten per cent positivity is really like, you have no clue what's going on in your community," said Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare in Hamilton.
"Things are running wild at that point."
WATCH: Infectious diseases doctor questions new Ontario restriction criteria
'You would hope you could act far before that'
Both Chagla and Dr. Isaac Bogoch, an infectious disease specialist at Toronto General Hospital, agreed that it was a plus that the province had laid out its criteria for moving health units into different levels of restrictions.
"It's great that they were able to create clear metrics," said Bogoch, saying that it will offer much-needed transparency to businesses and communities.
But it's the fine print that concerns him. Bogoch argues that a 10 per cent positivity rate in a place like Toronto — where the rate was most recently hovering just below four per cent — would be "very problematic."
Some of the metrics are too forgiving:<br><br>e.g.<br><br>-10% positivity<br>-Weekly Incidence of 100/100000<br><br>These would allow for significant community spread without imposing measures to curb transmission.—@BogochIsaac
"You would hope that you could act far before that," he said, adding that he expects the province is leaving the door open to tweak the numbers.
"If this is version one, and there's room to adjust, we'll be ok. If this is the final document, we certainly could get into hot water," he said.
Government has final call on whether unit hits threshold
Epidemiologist Colin Furness puts it more bluntly, arguing that the new guidelines, and especially the move to further re-open the province's hot spots, are a step firmly in the wrong direction and will inevitably lead to a jump in cases.
"The premier really wants businesses to be open, and he wants things to get really bad before he closes them down again," he said.
"By the time we move into red, it won't matter. We're going to have to go straight to gray [the highest level] and lock down. Having to close down so much more than restaurants is now a foregone conclusion."
Dr. Michael Warner, the medical director of critical care at Toronto's Michael Garron Hospital, also sees a difficult future ahead, saying the guidelines "enshrine exponential growth in hot-zone regions."
He's also concerned that the final decision on whether a unit will be moved from one level to another falls to the government.
"It gives the Ford government the ultimate trump card. They have complete control over the situation," he said.
Ottawa, Peel, Eastern Ontario and York Region are set to be in the orange category as of this Saturday, with Toronto following a week later.
The concept of opening up the economy when our public health infrastructure is on life-support demonstrates a blatant disregard for the need to shore up <a href="https://twitter.com/hashtag/TestTraceIsolate?src=hash&ref_src=twsrc%5Etfw">#TestTraceIsolate</a> first.—@drmwarner
With files from Lauren Pelley and Mike Crawley