November 25, 2020, Premier Doug Ford, Deputy Premier and Minister of Health, Christine Elliott, and Chief Medical Officer of Health, Dr. David Williams, issued preliminary public health guidance for Ontarians as they begin to plan for the 2020 holiday season.
Earlier today, the Auditor General (AG) of Ontario, Bonnie Lysyk, released a Special Report on Ontario’s response to the COVID-19 pandemic. The AG’s report focused on three key areas: emergency management and pandemic response; outbreak planning and decision-making; and laboratory testing, case management and contact tracing. Ultimately, the AG’s report concluded that Ontario’s COVID-19 response was slower and more reactive than that of other provinces, and that the response was not led by Dr. Williams and other public health officials.
In response to the AG’s report, Premier Ford said that he “would not support” claims that Dr. Williams was not leading Ontario’s response to the pandemic and that Dr. Williams and the broader health team have guided the government’s response to COVID-19 “since day one.” The Premier was critical of the AG for undermining the work of Dr. Williams, and emphasized that the AG role is not to offer health advice.
Ontario Public Health Guidance for the 2020 Holiday Season
This afternoon, Premier Ford, Minister Elliott, and Dr. Williams issued preliminary public health guidance for Ontarians ahead of the 2020 holiday season.
The guidance reminds Ontarians that the safest way to celebrate the holidays this year is by doing so only with those living in one’s own household. Those who live alone are permitted to join one other household.
Among the holiday activities categorized by provincial guidance as “safer” are virtual holiday gatherings, outdoor activities, drive-through events, and activities that Ontarians can participate in with those living in their home, including decorating, baking and watching movies. Activities that are categorized as “riskier” include in-person gatherings, hosting overnight guests, non-essential visits to family and friends, and travel from regions of high transmission to regions of lower transmission. The full list can be accessed here.
Ontarians are asked to consult public health measures for their region, and to comply with the measures required by their region’s COVID-19 level (Green, Yellow, Orange, Red, or Lockdown), as well as any additional restrictions in place locally.
The following social gathering limits are currently in place for each COVID-19 level. These limits do not apply to a gathering of members of a single household:
- Green, Yellow, and Orange levels: 10 people indoors and 25 people outdoors.
- Red level: 5 people indoors and 25 people outdoors.
- Lockdown: Indoor social gatherings are not permitted. Up to 10 people may gather outdoors.
A holiday web page will be launched shortly to provide up-to-date guidance on planning for a safe holiday season.
AG Special Report on Ontario’s Response to COVID-19
Earlier today, AG Bonnie Lysyk released a Special Report on Ontario’s response to the COVID-19 pandemic. The report focuses on the following three key areas:
- Emergency Management and Pandemic Response
Key findings within this section suggest that Ontario was not well-positioned to activate the response structure outlined in the province’s emergency response plan at the outset of the COVID-19 pandemic. Factors contributing to Ontario’s ill-preparedness included changing leadership and staffing shortages at the provincial emergency management office (EMO) as well as outdated emergency plans. Where other provinces were able to activate an existing response structure, Ontario instead hired an external consultant to create a new structure and a whole of government approach.
This section also suggests that EMO did not undertake detailed planning ahead of subsequent waves of COVID-19. Specifically, there has been no planning to account for winter hazards such as ice storms, which could lead to power outages and require residents to be evacuated from their homes.
- Outbreak Planning and Decision-Making
This section concludes that Ontario’s initial response to COVID-19 was slower and more reactive than the responses of other provinces, as a result of a “command structure that evolved to become cumbersome, with numerous participants at multiple tables and sub-tables.” The report also notes that public health officials did not hold the top leadership roles within Ontario’s COVID-19 command structure, and that expert advice was not always followed. In addition, this section points to “variations in management and operations among [Ontario’s 34] public health units” as a contributor to fragmentation and inconsistency across the province.
Significantly, the report finds that the key lesson from Severe Acute Respiratory Syndrome (SARS), namely “the need to act where there is reasonable evidence of impending threat to public harm,” was not followed, as demonstrated by the following examples:
- On February 16th, the Ministry of Health Emergency Operations Centre discouraged COVID-19 testing for most travellers, despite COVID-19 having already spread to numerous countries by this time.
- Travel advice provided by Ontario prior to March break was inconsistent with travel advice from other provinces and the federal government, which cautioned against non-essential travel earlier.
- Community transmission of COVID-19 was not formally acknowledged in Ontario until March 26th, despite strong evidence that community transmission was occurring in early-to-mid March.
- There was a delay in restricting long-term care home staff from working at multiple facilities. An emergency order limiting staff to one location did not come into effect until April 22, over a month after the province’s first outbreak in long-term care.
- Laboratory Testing, Case Management and Contact Tracing
This section found that laboratory testing, case management, and contact tracing for COVID-19 were not being performed in a timely enough manner to contain the spread of the virus.
In the “hotspot” regions of Peel, Toronto, and York, the report found that the Ministry of Health’s target of completing 80% of laboratory tests within two days was not being met. On average, these regions have also not been able to contact individuals who tested positive for COVID-19 within 24 hours of receiving the test result.
The report also found that densely populated regions including Ottawa, Peel, Toronto, and York took a longer-than average time to begin case management. Between September and October 2020, the average time between reporting a positive test result and starting case management was 4.5 days in Ottawa, 3.25 days in Peel, 4 days in Toronto, and 2.25 days in York. All of these regions fail to meet the Ministry of Health’s target of contacting at least 90% of close contacts of COVID-19 cases within 24 hours.
While the report notes that the Ministry of Health acted to expand capacity for testing and contact tracing, it also points to long-standing concerns with Ontario’s testing capacity and information systems. The section concludes that the Ministry of Health would have been better positioned to prioritize the testing of high-risk individuals and probable cases if these concerns had been addressed earlier.
In the near future, the AG plans to issue a second Special Report on Ontario’s response to COVID-19, containing chapters on the management of health-related COVID-19 expenditures, personal protective equipment, and long-term care issues.