Ontario’s COVID lockdown catch-22

New research suggests shorter, more frequent lockdowns are better for public health and the economy


Doug Ford rolled out phase two of the province’s vaccine plan on Friday. The plan is to vaccinate nine million Ontarians by the end of July. It’s going to be a tough mark to hit given that only some 269,000 Ontarians have so far been fully immunized. An online booking system won’t launch until March 15. The anticipated arrival of two more vaccines (AstraZeneca and Johnson & Johnson) was held out by Rick Hillier – the retired general put in charge of the province’s vaccination task force – as another reason for optimism.

The Ford government has invested a lot of its political capital in a vaccine getting Ontario back to some semblance of normal again. It’s been more than 100 days now under the latest stay-at-home order in Ontario, which is set to be lifted on March 8. The bad news is that this may not be the last winter that we’ll have to endure another cycle of on-again, off-again hibernation because of COVID-19.

Some modelling is already predicting the third wave in mid-April. Even with a vaccine, some 80 per cent of the population will have to be vaccinated to provide a bulwark against the disease. That’s made more difficult when children and young people under 18 cannot be vaccinated.

There continue to be a lot of moving parts when it comes to managing the coronavirus. Growing scientific opinion is that there may be no end in sight and that COVID-19 and its variants could become a seasonal occurrence. The World Health Organization predicted as much back in December. If we’re being honest, we likely won’t be out of the woods with current restrictions until 2022. The good news is we’re more than half way there. Yes, it’s been a blur.

Of course, this could have been avoided, most epidemiologists agree, if Ontario had followed the example of Australia and New Zealand, and put the hammer down earlier with longer lockdowns during the first wave of the virus and at the beginning of the second wave.

The UK, for example, has decided to lock down until the first day of summer (June 21) under its recently announced “roadmap” out of COVID-19. The plan is to lift the current lockdown in four stages, each lasting five weeks. The first order of business under the UK’s plan is the reopening of schools on March 8.

But even the June 21 target may be too ambitious, experts say, given the new variants of the virus floating in the breeze. Despite the successful rollout of the vaccine, the UK is still registering some 10,000 new COVID cases daily.

David Nabarro, the World Health Organization’s special envoy on COVID-19, raised eyebrows at the beginning of the second global wave last fall when he said that the WHO “do not advocate lockdowns as the primary measure for the control of the virus.” In other words, lockdowns shouldn’t be the primary strategy to fight the virus. As we’ve seen in other countries with robust testing and contact tracing in place, lockdowns have been the exception, not the rule.

It’s been a failure of the Ford government that we’ve had to rely on lockdowns to control the virus and bail out our overwhelmed hospitals. The fallout has been immeasurable on kids who’ve been deprived of in-person learning and parents who’ve had to stay home to take care of them – not to mention on our collective mental health and the economy. People’s livelihoods have been affected.

“Lockdown’s really are a last resort,” says Burlington-based family physician Jennifer Kwan,  “They’re a demonstration of failure. If we had been able to address high-risk situations, for example, like class sizes in schools and testing in workplaces and protecting long-term care, then we would have avoided lockdowns in the first place.”

And so here we are a year later.

Toronto and Peel are re-entering the grey zone on Monday and joining other parts of Ontario in re-opening retail with restrictions, but Health Minister Christine Elliott is still encouraging Ontarians to “stay at home as much as possible.” While Toronto and Peel are “making progress… case rates still remain high.”

But there’s a point of diminishing returns when it comes to getting people to adhere to public health restrictions. Some new modelling by researchers at York University suggests the longer lockdowns go, the more likely they are to induce COVID fatigue and cause people to start breaking the rules.

“This is not some well you can keep going back to again and again,” says Iain Moyles, an associate professor of mathematics and statistics at York University’s Canadian Centre for Disease Modelling (CCDM), whose research was recently published in the journal Royal Society Open Science. “Every time you stay home you’re incurring a cost to yourself. That could be a literal economic cost or it could be a social cost like not seeing your friends or loved ones. And that’s the part that starts to wear.”

Moyles says that “social fatigue,” can diminish the effectiveness of lockdowns and lead to worse health outcomes and increased costs. What is the exact breaking point is highly individual and depends on a host of factors.

Fear, for example. During the first wave when we didn’t know as much as we know now about the behaviour of the coronavirus – in particular, the threat posed by aerosol transmission – most people who could were happy to hibernate.

But even with the increased chances of transmission posed by new variants, Moyles says fear is only one variable for people when weighing the risks. How many people, for example, are still taking into account factors in their daily decisions like the fact that COVID-19 is an asymptomatic disease and can be spread by people not showing any outward signs?

The availability of a vaccine will play a larger role in the decision-making process of assessing risk. Hopefully, it won’t be a case of offering people a false sense of security.

“People who have been vaccinated can be safely seeing other people who also have been fully vaccinated, including the few weeks after your second dose,” Kwan says. “But there’s a lot of nuance to that, right? You can’t really tell who else is vaccinated if you go to a grocery store.”

Which means physical distancing and masks for the foreseeable future – and staying at home more than we’d like.

@enzodimatteo

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