Health·Analysis

Warnings ignored, action delayed: Ontario's road to its most dire COVID crisis

Ontario is in the midst of an unprecedented health-care crisis as the pandemic's third wave worsens. Front-line doctors say it could have been avoided had Ontario acted more decisively on early warnings.

Some experts fear province still not doing enough to calm the pandemic's third wave

Doctors say Ontario ignored crucial 3rd wave warnings

The National

27 days ago
2:59
Public health officials have been warning the Ontario government about a crushing third wave for months, but health-care workers say the government didn't listen and its slow reactions may have cost lives. 2:59

When Ontario Premier Doug Ford announced the current stay-at-home order on April 7, he said the province's COVID-19 crisis had become worse than predicted. 

"The capacity at the ICUs and these variants have taken off even beyond what they told us," the premier said. "And the second I found out yesterday, immediately I asked them to start writing up the orders."

But modelling presented two months earlier signalled the trouble to come. And on April 1, the week before Ford's announcement, projections showed a new stay-at-home order would be crucial to getting the increasingly devastating third wave under control. 

The scientists behind Ontario's COVID-19 modelling hit back at Premier Doug Ford after he said the modelling didn't show how bad Ontario's crisis would become. (Twitter: @covid19MC )

Despite that recommendation — and a letter from 153 ICU doctors imploring the province to take tougher action — Ontario waited nearly another week to issue the order. 

Some health experts say the Ford government's failure to act quickly and decisively on dire warnings has exacerbated the disaster and has ultimately cost lives. 

"I have been very reluctant to be so assertive, but, at this point in time, there is absolutely nothing that would allow me to conclude otherwise," said Dr. Andrew Morris, an infectious diseases specialist at the University of Toronto. 

"To suggest that any of this was unpredictable, surprising and occurred any faster than predicted is a fiction." 

Predicting a disaster  

On Feb. 11, things at least felt like they were looking up. 

Ontario was still under its previous stay-at-home order but cases had been on a downward trajectory for weeks. The third wave was a spectre then, not yet a reality. Still, the situation was precarious.

That day, Adalsteinn Brown, co-chair of a group of health experts advising the province, presented modelling that suggested if public health measures were lifted, hospitalizations and ICU admissions could quickly soar given the aggressive nature of the B117 variant, which had been first detected in the U.K. and was now spreading in Ontario. 

Adalsteinn Brown, co-chair of Ontario's COVID-19 science advisory table, delivers updated projections at Queen’s Park on Friday. The dire forecast led to more restrictions in the province. (Frank Gunn/The Canadian Press)

TVO reporter John Michael McGrath asked Brown a stark question: "Am I missing something here? Or is this presentation actually predicting a disaster?" 

"No. I don't think you're missing anything," Brown said after a pause. 

A key finding of the modelling was that "sticking with the stay-at-home order will help avoid a third wave and third lockdown." 

However, buoyed by the lower case counts back then, the Ford government began easing restrictions. On Feb. 16, just five days after Brown's presentation, the stay-at-home order was lifted across most of Ontario. Regions were moved to various levels of restrictions based on the province's colour-coded framework. 

By March 8, just as Ontario's COVID curve was beginning to rise again, the order had been lifted in Toronto and Peel, too, the areas with the highest caseloads.

They remained in lockdown but non-essential retail, and later patio dining, were both allowed to open at limited capacity. Indoor dining restrictions in other regions would be eased. 

On March 26, Ford was asked whether the province was opening too much, too soon given rising case counts and ICU admissions. 

Construction workers set up a makeshift hospital at Sunnybrook Hospital in Toronto back on March 11, 2021. (Nathan Denette/The Canadian Press)

The premier admitted he was concerned, but said: "I'm going to be frank. People are tired, I'm telling you. They're tired, they're exhausted out there. They need a little bit of fresh air. But please do it very carefully, that's all we're asking." 

By then, doctors had been sounding alarm bells for weeks. 

On March 10, two days after the stay-at-home order was lifted in Toronto, Dr. Kashif Pirzada, an emergency physician, shared his fears of a third wave with CBC's The National

The opening footage for that story was a field hospital being constructed at Toronto's Sunnybrook Hospital. 

"Today on my shift, I've seen more cases than I've seen in the last month," Pirzada said.

"All of the projections showed this would happen." 

Anthony Dale, president and CEO of the Ontario Hospital Association, was interviewed in the same story. 

At the time, there were more than 300 patients in the province's intensive care units. 

"You go into an intensive care unit anywhere in Ontario, but especially in our hot spots … and it's a war zone still," he said.

WATCH | Clear warnings a month ago:   

Concerns Ontario could enter third wave of COVID-19

The National

2 months ago
2:16
An uptick in COVID-19 cases in Ontario has doctors and officials concerned the province could experience a third wave as restrictions are loosened. 2:16

'Completely out of control' 

At the end of March, the number of COVID patients in Ontario's hospitals was 21 per cent higher than at the start of the last provincewide lockdown in December. ICU capacity was becoming dangerously stretched. 

"Right now in Ontario, the pandemic is completely out of control," Dr. Peter Juni, the scientific director of the group of experts advising the province, said in an interview with CBC News at the time. 

Juni said Ontario couldn't vaccinate its way out of the crisis and the only way to ward off disaster would be stronger public health measures — a plea other doctors were making, too. 

Morris, the infectious diseases specialist at the University of Toronto, developed a daily habit of tweeting: "Looking forward to Ontario's government announcing a plan today to prevent further unnecessary death and illness from COVID as cases rise exponentially."

Dr. Andrew Morris, an infectious diseases specialist at Toronto's Sinai Health and University Health Network, says the Ontario government's COVID-19 response has been inadequate. (Turgut Yeter/CBC)

In an interview this week, Morris, also a member of Ontario's COVID science table, said he'd hoped the provincial government would take notice. 

"There was a part of me that was hoping that at some point in time the light bulb would turn on and they would recognize that there were still many things that they could and should do to attenuate the third wave," he said. 

Second stay-at-home order 

Stronger provincewide action would not come until April 1, and it wouldn't go far enough.

That morning, the latest modelling presented by Brown indicated that flattening the curve would require a new stay-at-home order. 

"Under all the scenarios, cases grow for a little while. However, in both the two-week and four-week stay-at-home order, they start to break and come down," Brown said. 

The government didn't take that advice. Hours later, it instead announced what it called an emergency brake shutdown across Ontario, which permitted non-essential retail to remain open.  

The move was immediately condemned by many health-care workers as an inadequate half-measure. A video would emerge of a packed Toronto shopping centre over the Easter weekend. 

"A lot of people were going into the malls and doing their little wander around and coming out with no bags. So that tells me they were just out for an evening or daily jaunt. You can't do that," an angry Ford said during a news conference on April 6, referring to shoppers who were at businesses the province had allowed to stay open. 

Ontario Premier Doug Ford points on a COVID-19 caseload projection model graph during a news conference at Queen's Park in Toronto on Friday. Ontario is extending its stay-at-home order to six weeks, restricting interprovincial travel and limiting outdoor gatherings. (Frank Gunn/The Canadian Press)

The next day, April 7, careening case counts and hospitalizations forced the province to harden measures again. It announced the stay-at-home order Brown had recommended nearly a week prior. 

In a statement to CBC News, the Ford government defended its response to the third wave, asserting it has acted quickly and decisively throughout. 

But Dr. Naheed Dosani, a Toronto palliative care physician, says the province's delayed action on tougher measures allowed the crisis to deepen. 

"We probably could have avoided this catastrophe," he said. "This really should not have happened."

'What's done is done' 

Ontario now faces an unprecedented health emergency. Hospitals, intensive care units and health-care workers are all under unrelenting strain. 

The latest modelling from the science table shows even darker days ahead. Ontario could see up to 10,000 cases per day by the end of May. A record number of Ontarians are currently in hospital, and ICU figures could top 1,000 patients by the end of the month.

"I have not heard such fear from physicians who are usually stalwart, who soldier on no matter what," said Dr. Nadia Alam, a family physician and anesthetist who works on COVID-19 ICU wards. 

"I'm afraid of the choices we're going to be forced to make." 

Those choices may include deciding who lives and who dies as hospital capacity runs out. 

"We need the government to do better. There is no doubt about that," Alam said.

Doing better, many health experts argue, includes providing paid sick leave to essential workers, many of them from communities of colour, as they are among those bearing the brunt of the pandemic. 

Ford has accused those demanding paid sick leave from the province of playing politics, pointing out the federal government's Canada recovery sickness benefit (CRSB) is available. 

The CRSB requires an employee to miss at least half a week of work and they can only apply for the benefit the week after they've been off sick. 

Advocates say it's no replacement for guaranteed paid sick leave for someone who may not be able to afford to stay home when ill. 

"What's done is done," said Dr. Dosani. "Now, it would be really great if we just focused on the evidence, the lessons learned and take the necessary steps to support people." 

Medical experts say concern over the lack of paid sick leave is another crucial warning going unheeded by the Ford government — and that inaction will only prolong the province's suffering.

ABOUT THE AUTHOR

Ellen Mauro is a senior reporter based in Toronto. She was formerly posted in Washington, D.C. where she covered the Trump White House for CBC News. Previously, she was posted to CBC's London, U.K. bureau where she covered stories across Europe and Africa.

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