Ontario rejected advice from its public health agency when it launched its color-coded plan for COVID-19 restrictions


The province rejected the advice of its public health agency when it created its new color-coded framework for COVID-19 restrictions, and the executive leading the organization’s pandemic response says it only learned crucial details when were publicly released last week, the Star Has Learned.

Health Minister Christine Elliott told reporters Friday that the framework was “designed after consultation and comprehensive advice” by two expert advisory groups – the public health measures table and the model consensus table – as well as the dr.

But one group said he was never consulted, and a member of the other group said he had never seen the final plan before it was released. In interviews with the Star, they described the framework’s controls as insufficient to contain the spread of the virus, putting Ontario’s health system and its most vulnerable citizens at risk.

In September, the Ministry of Health asked Ontario Public Health to provide advice on epidemiological indicators for the picture, said Dr. Shelley Deeks, the agency’s health protection officer, who also sits on the province’s health table. .

PHO advised on four levels of control measures. To move to the more stringent level less than a full block – a category now known as red or “control” – PHO has recommended a threshold of a weekly infection rate of 25 cases per 100,000 people and a positive laboratory test rate 2.5%, Deeks said.

But in the final plan, which Deeks said he only saw last Tuesday when it was announced to the public, those thresholds were set four times higher: at 100 cases per 100,000 and 10 percent.

“This surprised me,” she said in an interview, adding that she stayed close to the PHO recommended thresholds in September. “I disagree with the indicators as they are currently written in the framework.”

In September, the health ministry asked Ontario public health for advice on epidemiological indicators for the reopening framework, said Dr. Shelley Deeks, PHO's head of health protection.  But he said he didn't agree with the final plan.

Beate Sander, co-chair of the Ontario COVID-19 Modeling Consensus Table, said Minister Elliott “spoke badly” at a Friday news conference when she said her group members had provided advice.

“The Modeling Consensus Table has not been consulted,” said Sander, a University Health Network scientist and Canada Research Chair in Economics of Infectious Diseases, adding that she and other members of the scientific community were “surprised” by the plan.

“I agree that the thresholds are very, very, high,” he said.

“The risk is that we will not be able to control the increase in the number of cases, which means that we are also risking our hospitals being overwhelmed. In some of the areas where the number of cases is already high, we have already started to see it. “

Provincial officials say the framework was intended as a “proactive” plan that would provide clarity and predictability for the public and businesses, many of which are struggling to stay afloat and plan ahead in the face of abruptly changing health measures.

Experts have criticized the picture for being dangerously lax. Health units in critical areas, such as Peel and Toronto, have since introduced additional measures to try to keep their spiral outbreaks under control.

Under the province’s plan, Toronto is expected to enter the red level of “control” on Saturday, which would reopen indoor restaurants and bars, fitness classes, casinos and bingo halls. But on Monday, Toronto’s health officer, Dr. Eileen de Villa, relied on her legal authority to keep them closed, citing the city’s growing number of cases and positive tests.

The Star asked the Ministry of Health for the names of the health experts and advisory bodies that proposed the thresholds for each level. The ministry did not answer this question, but said the picture was “informed by data, evidence and information, including from other jurisdictions, and approved by the government.”

“Public health experts such as the Chief Medical Officer of Health, Office of the Chief Medical Officer of Health, Public Health Measures Table and local health officers have provided input on the overall concept and direction for the framework,” said spokesperson Adam. Hendy.

Deeks sits on the public health measures table as the representative of PHO, where he is executive responsible for the public health response for COVID.

Both the PHO and the health measures table advised the province on its reopening framework, Deeks said. But because the province’s public health measures table board is confidential, he declined to share the details of those conversations.

Deeks said he supports the province’s decision to release a framework with several control categories and clear indicators that support the transition from one level to another.



“I think that increasing restrictions or indicator-based public health measures is actually a really useful thing,” he said. “And I think it’s useful to communicate it to the public so that they understand.”

But the indicators recommended by the OFO are nowhere to be found in the province’s final plan. At the lowest level – now known as green or “prevent” – the province thresholds are double what PHO recommended, which was a 10 per 100,000 weekly incidence rate and one percent positivity rate, according to Deeks.

Health Minister Christine Elliott told reporters Friday that the picture was "designed after full consultation and advice" from two expert advisory groups, the Public Health Measurements Table and the Model Consensus Table, as well as Dr. David Williams, Chief Health Medical Officer.

And at the highest level of “scrutiny” before going into lockdown, the province’s indicators are four times higher than the OFO’s recommended, meaning it will take much longer for regions to enter this category and impose measures. necessary.

Deeks acknowledged that he must consider these thresholds only from a disease control perspective and does not face the difficult task of the government of having to weigh social and economic considerations as well.

But he explained that PHO’s recommendations were founded on the awareness that early action is crucial to controlling COVID. When looking around in other jurisdictions, the lesson was always the same: the stronger the increase in new cases, the longer – and harder – the control measures required.

“We are taking action earlier to avoid the need for more aggressive action later,” he said. “It’s actually harder to control a disease when there’s so much more than one disease out there.”

Sander agreed.

“Delaying stricter measures or stricter measures generally means that we will find ourselves for a longer period of time, because at that point it is so out of control that it takes much longer to get back to a level we can easily manage, where we can have a sort of semblance of normal life “.

Deeks said the recommendations also need to consider the reality that the most vulnerable populations have been hit hardest by the pandemic, including elderly residents in long-term care homes. “This is troubling to me because we know that with COVID they are more likely to get seriously ill, so it’s harder to control when it’s in that population.”

He said a vaccine is now on the horizon and a glimmer of hope. But current numbers in hot spots like Peel and Toronto are already worse than they were in the first wave, and we’re not at the peak of this wave yet, he said.

Deeks’ voice broke with emotion when he talked about the effect the outbreak will have on vulnerable populations and the sacrifices that will be required to keep everyone safe.

“I know it’s tiring, that people are tired,” he said, struggling to maintain his composure. “I’m really scared with numbers like this that will spill over to the elderly again and we’ll see more deaths.

“I think it will get worse before it gets better, and we have to be prepared for that. And we must act. “

Jennifer Yang |
Kate Allen
Kate Allen is a Toronto-based journalist covering science and technology for the Star. Follow her on Twitter: @katecallen



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