Ontario's COVID-19 framework isn't perfect, but can be tailored, docs say

Some health officials are saying Ontario's new COVID-19 framework should be tweaked, but it needs to stay in place to curb the spread of the virus.

The province's new framework focuses on the number of cases in a region during a week-long period, as well as the percentage of positive COVID-19 tests per region.

It has five levels, ranging from 'prevent', which is green, to 'lock-down', which is grey.

Alain Simard, an immunologist and associate professor with the Northern Ontario School of Medicine in Sudbury, says he doesn't think it goes far enough, but understands what the province is trying to do.

"There's been a lot of criticism on this whole new scheme, because a lot of the health units and the Ontario Medical Association as well, spoke out against this new grading scheme because the measures that are in place don't really reflect the severity of the situation, and they're not stringent enough," he said.

"In the green, the measures are pretty relaxed. And then if you go to the yellow, most of the new restrictions focus on businesses and they don't necessarily further limit sufficiently the activities that are at higher risk." 

Finding a 'sweet spot'

Physician and epidemiologist Dr. Peter Yuni, who is also the scientific director of Ontario's Science Advisory Table on COVID-19, says the framework can be tailored locally.

"We need to find a sweet spot and also acknowledge that all these restrictions that we are doing are harmful," he said.

"We also need to acknowledge that nobody can pinpoint exactly what the right thresholds are. But the current thresholds ... I think most of us agree these thresholds are just too high. I would be pleased if these would be halved."

Northeastern Ontario is currently in a green zone, but in the Public Health Sudbury and District area, a recent spike in cases has moved the region's case rate into the yellow zone, Simard says, although no local leaders have officially announced that.

"When the numbers first came out about a week ago with a huge spike, I told myself, I'll wait for the next week. It's going to be very telling to know whether or not this could have potentially spread further in our community," he said.

"And luckily, the numbers have gone down, but they're hovering around a four or five new cases per day, which is still fairly high compared to what we've had in the past. There is still a risk that this could spread further. And the more that it spreads, then the harder it is to regain control of the pandemic."

Simard says it seems like the province is trying to create a system where they can prioritize keeping businesses open.

"And there are many reasons to think why they would want to do that, because having a complete shutdown was very difficult for, not only for the economy, but also on a personal level, because a lot of businesses had to close. And we're talking about the livelihood of people here. So they're trying to definitely trying to protect that," Simard said.

"At the same time, they have to try and balance public health, as well in safety. And I think that's where it becomes very difficult to find that balance. And in this case here, they're not really going far enough to try and protect public health and put strict guidelines."

Leaders in a tough spot

Yuni agrees that the current framework thresholds are too high. And that's where local decision-makers need to step in.

"The local public health unit has the possibility also to become more stringent. That's what's happening right now in Toronto," he said.

"And this is really important right now."

Yuni says he and his research team are trying to provide local decision-makers with as much evidence as they can to help them with judgment calls.

"My group is working on that as we speak, right now. And I would believe that we can have these discussions relatively soon in one to two weeks."

He says the province still needs to be "a strong central processing place to avoid paralysis in the periphery."

The closer that local politicians are to their voters, the more difficult it will be for them to make objective decisions.

"Therefore, it is important to have a good framework," Yuni said.

"We have one that needs to be adapted, but it could become a good framework. To have transparency and to have central support of the processes and central decision making as well. So, I would be much more pleased if, in a few weeks, that we have cut-offs that are OK. And that we can move according to this framework and support the local public health units to do the right thing."