Message couldn’t be more clear: stay home

The provincial announcement of a lockdown starting Boxing Day is welcome news, says Dr. Mustafa Hirji, but he would have liked to see it happen sooner.

“I think the timing is a little bit too late. I think it is perhaps a missed opportunity that they didn’t announce it Friday, and that they’re going to wait four and a half days before it actually happens,” the Niagara acting medical officer of health said earlier this week.

Instead, Friday’s announcement included the news that Niagara would move into the red zone Monday, increasing limits on businesses this week, until Boxing Day restrictions, similar to the lockdown we experienced in March, come into effect.

Hirji references statistics indicating that with the current growth rate of COVID-19 cases in Ontario, the delay of the lockdown by seven days adds up to 45,000-plus new cases. “Once they’d made the decision, they shouldn’t have delayed putting it in place. That delay means literally tens of thousands of additional cases, and probably hundreds of people being hospitalized.”

With the lockdown in place, the most important step for Public Health is getting across the message that people really should stay home, the way we did in the spring, says Hirji.

“We all need to stay home, and limit contact with other people, so we get the full benefit of this lockdown, so we don’t come to the end of January and have it extended longer, or get to February or March where we need to go back into lockdown because this one wasn’t effective.”

He’s concerned that during the week of delay between the announcement and when the lockdown begins on Boxing Day, “some people might rush out and do what we asked them not to do. It really doesn’t make a lot of sense to me. The decision was that we need to go into lockdown, and we should have done it right away.”

What will ultimately bring the number of cases down is not so much restriction on businesses, which will be closed with the exception of those which are essential services, but having people follow through with the advice “to stay home and not be out interacting with other people. That’s what’s really going to matter,” says Hirji.

Niagara hospitals  and long-term care homes “are stretched,” losing staff not necessarily because they have COVID-19, but likely because someone in their household is infected and they need to isolate so they’re not taking it to work with them, he says.

Resources for contact tracing have also been stretched, and staff are not managing to follow up on 100 per cent of the cases, he says. “This is the first time that’s happened.”

They’re not doing as thorough a job as they were, concentrating on trying to contact everyone rather than getting information about patterns and trends and how people are being infected. “That’s information we no longer have time to collect,” says Hirji.

Last weekend and early this week saw record numbers of cases in Niagara Region, beginning with 126 recorded last Saturday, more than double any other day since the pandemic started. Sunday saw another 92 new cases, and Monday 82 more.

In Niagara-on-the Lake, Tuesday’s number of cases to date reached 80, up from 71 the week before. It was another leap after months of slowly increasing numbers, typically one or two a week, and many weeks with no new reports. One resident was part of a hospital outbreak, and others were within households, with a little bit of spread from friends or co-workers, very much the same kind of pattern as everywhere else, says Hirji.

Across the region, more than 50 per cent of the cases of the last two weeks are linked to outbreaks in long-term care and retirement homes, and to a lesser extent, hospitals, says Hirji. Infection rates rise in those settings because there are more cases in the community, he says.

Typically, a staff person, or a family member who’s visiting a loved one, has been infected in the community and brings it in. “When cases go up in the community, I think it’s unavoidable,  and then it becomes a matter of how we control those outbreaks when they happen.”

While visiting is restricted in long-term care homes, it’s not entirely prohibited, he says, “and rightly so. I would be very reluctant to say people who are at the end of their life are not allowed to spend time with their loved ones, so there is some limited visiting still happening.” Visitors and staff are being tested regularly, he says, but it’s not a foolproof method, with a lapse in time before results are known. “You just can’t catch 100 per cent of the cases. And when there are more cases in the community, there is going to be greater risk that some infections are going to get into the homes.”

Other than those specific outbreaks, which earlier this week included 11 hospital units, long-term care and retirement homes across the region, the spread in the community has been similar to what we’ve seen in the past few weeks, says Hirji, involving households, people socializing with friends, co-workers and extended family.

As we head into the holidays, Hirji says his overwhelming reaction to what is happening is sadness. “It’s really unfortunate we’re in a situation where something really dramatic like this is needed to bring COVID-19 under control. I think it’s unfortunate that there are lots of people who are going to really struggle through the next four weeks with this lockdown. There are gong to be people who are for sure going to be out of work and no longer have an income. Lots of people are going to be struggling with social isolation, and heading into the holiday season is the worst time for this to be happening. Lots of businesses are going to have to shutter temporarily, and many of them are already struggling.” 

The lockdown needs to happen to bring COVID under control, he says, but stresses it’s only going to have the intended benefit “if it’s also coupled with all of us taking the advice to stay home, limiting our time outside of the home, limiting our interactions with other people. If we continue to still interact with other people, still find ways to visit other people, we’re not going to get the benefit of the lockdown. And if we don’t bring cases down we’ll be in the same situation as the U.K., where they just headed into their third lockdown, or France, which had to extend their lockdown.”

Hirji says front-line workers, in public health, in long-term care homes, and in hospitals won’t be getting much of a break over the holiday. “Staff in health care are not going to have a very happy Christmas,” he says. But those he worries most about are those who are going to be out of work, or are struggling with isolation and mental health issues. 

“I think we really need to take the advice to heart, and just stay home. We should be doing it for everybody who is impacted by COVID.”