The escalating catastrophe of the COVID-19 second wave in Ontario

RNAO has been a leading voice since the end of the first wave in summer 2020 calling on government to engage measures to pre-empt and prevent the unavoidable second wave in the fall.

On July 24, 2020, we asked in this blog: Preparing for the second wave of COVID-19: What is the plan? We proposed a detailed plan of how government must act to make sure the second wave is not a recurrent tragedy. I wrote: “Let me begin by repeating what I have begged government at all levels since January, and in particular from Ontario’s Chief Medical Officer of Health David Williams: We must prepare for the worst and hope for the best. During the first wave of COVID-19 in Ontario, we had it backwards – we hoped for the best, but engaged action late and at a slow pace, thus ending in the middle of the pack.”

Tragically – although entirely avoidable – today we find ourselves in a much worse situation than during the first wave, and for the same reason of “too little, too late.” This week, on January 12, RNAO issued a media release, urging Premier Doug Ford to deliver on his promise to do everything in his power to defeat COVID-19. RNAO re-issued its request to implement – effective immediately – the following measures:

• A full province-wide lockdown as during the first wave of this pandemic, plus a curfew similar to the one in effect in Quebec. 
• No reopening of schools (we welcomed the province’s decision made on Jan. 7 in regards to hot zones in Ontario).
• Increased supports for vulnerable populations, including safe places to isolate, paid sick days and a moratorium on evictions.
• Vaccinations 24-hours-a-day, seven-days-a-week for residents, their essential care partners and staff in long-term care homes.

With modelling predictions that suggest COVID-19 case counts will rise to more than 5,000 per day and as high as 10,000 within the coming weeks in Ontario (40,000 under the worst scenario), a failure to act with swift and immediate measures will lead to catastrophic – yet preventable consequences. We said in the media release that “The pattern of ‘too little, too late’ has led to increasing numbers of COVID-19-related deaths, delays for non-COVID-19 surgeries, procedures and treatments, and the inevitable premature and preventable deaths resulting from those delays. It has also led to increased staff burnout.” We implored Premier Ford to act swiftly today (Jan 12).

Later in January 12, Premier Doug Ford announced the latest set of measures to address the second wave. He declared a state of emergency in response to rapidly escalating cases of COVID-19. He had little choice since various measures this government has enacted to flatten the curve have proven futile. Both the number of new cases and the speed at which the virus is spreading throughout communities are alarming, to say the least. There is the major concern that the UK variant, much more easily transmitted, may take hold in Ontario within a few weeks.

The measures announced by the premier sound like tough talk and concrete action, however, they fall short of delivering what is needed to avoid an unthinkable death toll and the collapse of emergency departments and ICUs – which we are now witnessing. In numerous media interviews and on social media, we at RNAO described these measures as not enough, too little, too late and – since we are in an intensifying tragedy – calculated recklessness. In December, Premier Ford decided to keep stores open for five more days before starting the lockdown so they could complete their inventory. My reaction was that “the inventory of illness and death is never worth the inventory of business. The latter is reparable –  lost lives are not.” My tweet below, sent out of sheer desperation, tells you how fast our tragedy is evolving. I plea to all my readers to RT right away, as we MUST do all we can to help our Premier regain reason and do what is right for Ontarians.    

Next we address the areas that RNAO has identified as essential for success:

Lockdown and curfew: The reason RNAO has been advocating for movement restrictions, such as a stricter and enforceable lockdown or a curfew, is simple: one third of Ontarians are not abiding by health directives. Contact-tracing efforts are not working. Highways are jammed, in contrast to the empty streets and highways during the first wave. And, of course, critical care is becoming overwhelmed.

COVID-19 infections continue to rise and long-term care residents by and large, have been the casualties of this inaction. Ontario has surpassed 5,100 deaths and seniors’ deaths in nursing homes represent more than 3,000 of those. It’s a shameful statistic and we will live with the knowledge that they were entirely preventable. Hospital ICUs are filling up and are under tremendous pressure; this has drastic consequences for people diagnosed with COVID-19 and those in need of non COVID-19 procedures, treatments and/or surgeries. The result is delays in care for others leading to premature and unnecessary deaths and a health system that continues to collapse in front of our eyes. Racialized and marginalized groups in society bear the brunt of the pandemic, with higher burden of illness and mortality (and they also suffer the most with the measures put in place to respond to the pandemic – see below).

All this affects healthcare workers directly. Many of you have been working day in and day out, without taking vacations and enduring the stress and burnout of fighting the pandemic for months. We know this is having a profound effect on you and your families. Please know that we have your back and are fighting on your behalf.

We urged a curfew as a last resort to restrict movement given that earlier measures have not helped. Too many people do not heed the advice, stay at home and refrain from meeting with others outside their immediate households. Rather than making it clear what is needed, the measures announced this week have caused confusion. For example, they ask people not to go out unless it is essential – such as for groceries, medical appointments or the pharmacy –, and yet, they allow non-essential retailers to continue offering curbside pick-up. This is incoherent. There is also no rationale for the decision to keep big box stores open for non-essential products; it is unfair for small businesses that are suffering and raises the question whether lobbying power drives health directives. All this results in confusion, more uncertainty and is an open invitation for people to engage in unnecessary contacts, driving the transmission.

Not re-opening schools: We applaud the government’s decision to extend online learning in five of Ontario’s so-called hot zones until Feb. 10 (Hamilton, Peel, Toronto, York and Windsor-Essex). We were already in support of government’s decision to delay the start of in-class instruction to contain the spread of the virus and the troubling number of infections among school-age children. We do recognize that not all children have the proper conditions at home and some may not be in a safe situation. We ask that available teaching staff and school nurses, including the 625 public health nurses approved for schools last September, maintain contact with children and parents to make sure all children are safe. It is important that this period when the school buildings are empty should be used to ensure schools are safe when they reopen later. This includes addressing issues flagged for quite some time, such as class sizes and ventilation.   

Increased supports for vulnerable populations: The long-standing structural inequities in our society means that low income, marginalized and racialized populations have suffered the highest burden of COVID-19.  

Many essential workers lack the workplace supports to protect themselves and their families. They do not have the luxury of working from home, and they worry about how they will pay their bills. Their precarious employment means they lack access to paid sick days or do not live in housing that provides them with adequate space to self isolate safely from family members if they have been exposed to the virus, or worse, test positive for COVID-19.

They also represent a disproportionate number of those who have tested positive and unknowingly have helped accelerate transmission rates within their communities. They carry a disproportionate burden of illness and death as a result from infection with the virus. Supports that allow people to stay isolated safely are critical public health measures.

Government needs to step in to help. Most importantly at this time, essential workers need access to paid sick days and the federal benefit Premier Ford touts as an option is inadequate. People in PEI and Quebec have access to paid sick days. There is more that Ontario can and should do. RNAO has long advocated for paid sick days. That’s why we urge the government to provide 10 paid sick days for workers without the federal benefit.

Also needed are more places – across Ontario – where people can self–isolate, especially for those who live in crowded accommodation and are unable to isolate from other family members.

For those tenants who are facing hardship and eviction, we thank the government for responding to our call for a moratorium with a temporary pause on enforcement of residential evictions. But the government needs to go much farther. The Landlord Tenant Board (LTB) must stop hearing eviction applications during the pandemic. They are not providing tenants with adequate access to counsel and representation and a fair hearing. Also, the moratorium needs to extend beyond the duration of the province’s emergency order because the economic impacts of this pandemic will have devastating effects on most tenants long after it is over.   

Finally, I want to address how hard it is to advice on health directives given the impact on racialized communities. RNAO has given advice to scale up the enforcement of health directives, such as a curfew or a stay-at-home order, with a heavy heart. On the one hand, they are essential to flatten the curve, which is hitting the worst among these communities. On the other hand, “enforcement” means potentially more encounters in the street of people who work in essential jobs with police (as could happen now with the stay-at-home order or could have happened with a curfew). We are aware of the terrible history of encounters between Indigenous, Black and other stigmatized communities with the police and other law-and-order officers. We appreciate that the government has clearly stated the lockdown order does not apply to persons experiencing homelessness.

RNAO is sending, in the most vocal way, a message to governments, police and other agencies at all levels, that the enforcement of health directives should not be an excuse to torment, once again, those who are just doing their jobs, so that others in more privileged positions can have the essential goods and services they require. We commit to watching very closely, and speak out should the ugly face of discrimination and racial profiling arise. We call on all our readers to be watchful that the pressures of the pandemic are not used as an excuse for stigmatization, harassment, hate and discrimination.   

Vaccination: See our discussion in a separate article.