'Lockdown light' failed in Canada's hardest-hit regions. Here's what experts say should happen now
Ontario and Quebec hesitated in a worsening second wave, now face more severe restrictions
There's no getting around it — lockdown measures don't seem to be working in Ontario and Quebec the second time around.
Health experts say Canada's hardest-hit provinces have consistently failed to contain the spread of COVID-19 with inadequate, poorly timed restrictions, leaving little choice but for much more draconian rules to be introduced.
But where exactly did we go wrong? And where do we go from here?
Despite declaring lockdowns as they'd done to control the spread of COVID-19 in the pandemic's first wave, Ontario and Quebec hesitated to impose strict enough measures to prevent an even deadlier second wave, some experts say.
"The first lockdown was extreme. Everything was closed, everything, and people were really discouraged from even leaving their houses as well. People were terrified and so they were more likely to comply," said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.
"Now, there isn't a lockdown — some businesses are closed but many are open still. So people are still going about their business, people are still socializing, because the fear is gone."
'It just keeps getting worse'
In the spring, when much of the country went into widespread, severely restrictive lockdowns to stop the mysterious spread of a new virus we knew little about, the high level of compliance was obvious.
"Nobody was on the street. It was like a neutron bomb went off," said Dr. Michael Gardam, an infectious diseases expert in Toronto and senior medical adviser for Health PEI.
"And if you compare that to today, the highways are full, there are people everywhere. There is so much more interpersonal contact now than there was back in the spring, and I think that's your answer — it's not the same lockdown at all."
Ontario Premier Doug Ford imposed what he calls a provincewide lockdown on Boxing Day in an effort to address the alarming rise of COVID-19 cases, hospitalizations and deaths.
WATCH | Ontario premier implores people to follow public health protocols, talks about state of pandemic:
"We're in a desperate situation," Ford said during a news conference Friday. "There will be further measures, because this is getting out of control."
Despite his alarm, the premier didn't actually announce any new measures.
But two weeks after the new lockdown was put in place, as the head of the Ontario Hospital Association warns of looming disaster, it's clear to some experts that much more needs to be done.
"Ontario keeps opting for 'lockdown light.' It just doesn't get aggressive enough, and so you have this slow trickle of increase which has just really worn everybody down to the absolute maximum," said Gardam. "Everybody in health care is so exhausted and yet there's more coming and it just keeps getting worse."
Hesitation led to worsening situation
Ashleigh Tuite, an infectious disease epidemiologist and assistant professor at the University of Toronto's Dalla Lana School of Public Health, said the problem is that Ontario and Quebec tried to be more strategic with their lockdowns in the second wave.
Non-essential businesses were left open, travel wasn't restricted effectively, and the provinces only reacted when the situation turned dire.
"At this point, we're on a pretty scary trajectory if you look at the ICU numbers, if you look at the hospitalizations and if you look at what's happening in long-term care," she said. "If you talk to people who work in public health, there is this sense of dread in terms of what is happening right now and what is to come."
The situation is so bad that Ontario is now preparing hospitals to transfer potentially hundreds of patients to different regions of the province amid a shortage of beds and an unrelenting rise in COVID-19 levels in several hot spots.
Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto, said the "critical pressures" on the health-care system are even worse now than in the first wave.
"I'm not sure how much longer the hospitals are going to be able to accommodate the volumes of COVID patients coming in," she said. "We can maybe hold our fort for a little bit, but at any point in time we can tip over."
In response to the worsening situation in hospitals and the unprecedented surge in COVID-19 cases, the Ontario government seems to be hesitating once again before deciding whether to implement new restrictions.
"We need to approach this like the crisis that it is. We also need to adopt the mindset that every day is a new day, and start afresh with our approach if needed," said Dr. Irfan Dhalla, vice-president of physician quality at Unity Health, which includes St. Michael's and St. Joseph's hospitals in Toronto.
"We need to be communicating clearly, and not sending mixed messages. We need to use restrictions and lockdowns to reduce transmission substantially, and only open up when we have the capacity to contain the virus with public health interventions like testing, contact tracing, and quarantine."
WATCH | Quebec imposes a curfew:
Quebec has taken the extraordinary step of implementing an 8 p.m. to 5 a.m. curfew, beginning Saturday and running for the next four weeks, which is the first of its kind in Canada since the pandemic began.
"The upcoming month is going to be a critical one," Premier François Legault said at a news conference Wednesday where he announced the new measures. "We are in a race against time."
But critics were quick to point out the new restrictions didn't include any limits on the manufacturing or construction sectors or a prolonged break for schools, which, combined, have accounted for a large portion of outbreaks in recent weeks.
"All policymakers can do is create environments and incentives and disincentives to encourage certain behaviours," said Deonandan.
"Ultimately, it's always up to the people to do what needs to be done."
Will stricter measures work?
While the decision to impose a curfew has come under fire from some health experts and advocates and the effect it will have on COVID-19 levels in Quebec remains to be seen, Hota says it will likely make an impact.
"It certainly sends a clear message to people that the expectation is we don't see people on the street," she said.
Its success will depend on how well it is enforced, she said.
"If you are breaking the rules, then who's actually going to call you on it? Or are we just going to let it happen?"
Gardam says a stricter lockdown in Ontario would likely help drive cases down to manageable levels. He suspects the government's hesitance may be due to the potential political fallout.
"The solution to this is available and it's been proven," he said. "It's just really unpalatable for politicians to do that, and so they keep skirting around it."
Gardam says if Ontario brought in the type of lockdown that Australia successfully used to control the spread of COVID-19 in its first wave, the province would be in a much better situation.
When Australia was hit with a surge of COVID-19 cases in late July, it prompted one of the world's longest lockdowns in Melbourne that closed virtually everything that wasn't a grocery store or hospital for nearly four months.
"If you brought in a very strict lockdown like that, your cases would go down," he said. "We've got ample evidence of that from other parts of the world."
He said the length of the lockdown would depend on how quickly cases dropped.
Deonandan said he's concerned more severe lockdowns may lead to more resistance from the public.
"Ultimately, if people are not willing to comply, it's going to fail," he said. "The tighter we put these restrictions, the more likely people push back on them."
While the best approach would be to try to drive the case numbers down as quickly as possible, that may not be politically or psychologically possible, he said.
"Do I think people have a tolerance for that? Honestly, I don't think so."
But Hota says anything short of drastic restrictions now will once again fall short of addressing a second wave that is quickly on the verge of getting out of control in hospitals.
She acknowledges that's a lot to ask, given that people have already been told to stay home for almost a year at this point. But the reality, she said, is it's going to take more than just a four-week circuit breaker-type lockdown to turn things around.
Making it work requires providing very clear advice on what is allowable and what's not, she said.
"If we choose not to, then we have to live with this, which is not sustainable from my perspective."
The key as Dhalla sees it, is to better apply all that we have learned in the past 10 months so we can contain the pandemic once and for all.
"Then, we can manage sporadic, local outbreaks the way they are managed in Asia, Australia and New Zealand, all while we continue to vaccinate people as fast as we can."