Stay-at-home order necessary, says Hirji

UPDATE: Doug Ford declared a state of emergency for Ontario and a stay-at-home order beginning at 12:01a.m. Thursday.

If the province does not call for further restrictions or a stay-at-home order soon — possibly as soon as today — it’s likely the current shutdown will not be enough to control the spread of infection, and we’ll be looking at two months of it instead of one, says the region’s top medical officer.

That was Dr. Mustafa Hirji’s prediction Tuesday during his weekly press briefing, but he isn’t alone in his thinking.

He, and other medical officers of health across Ontario, wrote to the province last week asking for further restrictions to be enacted.

“I would absolutely agree with the recommendation that we should have gone to a stay-at-home order,” he says. The science table shows, even with that, we could still be in a “pretty dangerous place” with hospitalizations and ICU admissions . "We should be doing at least that.”

The last two lockdowns “have actually worked,” he says, but having retail stores open doesn’t make sense. 

The medical officers didn’t receive an answer from their letter, but if Ford is paying attention, it may come in the form of an announcement this week.

Projecting to the future, if the lockdown doesn’t change the trajectory of COVID, Hirji says the next steps could be looking at curfews, requiring passes to travel certain distances, and the province shutting down travel across public health units.

He could see that helping stop the spread in tourist areas, as people from the GTA and Hamilton travel to Niagara, but it would have to be a provincial initiative.

Hirji, the region’s acting chief medical officer of health, says there has been a sharp increase of variant cases in the last two weeks, which was expected, but even the non-variant number is rising across the province. Hospitalizations and admission to intensive care units are also climbing. We’re close to a peak similar to the second wave, he says, and will likely surpass it within the week. “I expect the third wave is going to be larger than our second wave,” as a result of what he is seeing in Niagara and across the province.

If nothing changes, the Ontario Science Table is showing the number of daily cases could double by the end of April, from the 3,000 we’re seeing now to closer to 6,000. 

A combination of vaccinations with a stay-at-home order or similar kind of lockdown might see cases peak by mid-April and then start to come down, but they would likely start to rise again as soon as the lockdown is lifted.

“You buy yourself a little bit longer before you lift off the lid from the pressure cooker,” he says, but “that’s assuming the province would be in a stay-at-home order,” which hadn’t happened by Tuesday.

“It’s quite possible that a month from now we could still see cases higher than where they are right now.”

And if that’s the case, a month from now the province will have to decide on extending the lockdown, he added.

He also warned that admissions to hospital and ICUs will be later to rise, as a “lagging metric compared to cases. It’s quite possible we would still be at that very high level of ICU admissions even a month out,” another reason why he suspects the lockdown will be more than a month. “I see ICUs being at a really critical level a month from now, and we’re going to need to stay in lockdown quite a ways longer before we actually see our cases coming down.”

He’s also concerned about the P1 variant from Brazil, which has turned B.C. into a hot spot, coming to Ontario. 

“This variant is one I’m going to pay attention to, because there is a risk that we could see it.”

It’s more severe in terms of illness, so would put even greater pressure on hospitals, and is also the most resistant to our vaccinations.

It could mean that his hopes for the summer may be delayed, he says. Just two weeks ago, he was feeling optimistic about the freedoms we might be able to enjoy, even by May or June, when we have a majority of the population vaccinated. Instead, he says, we might not be able to reopen as quickly as he had thought — those freedoms are looking like they may be a little further off.

“I was really hoping that by the mid to later part of the summer we could start to see things looking very similar to what they were last summer, where most things are open.”

The P1 variant “could put a damper on that.”

The spread of the British B117 is the one that is dominant now in Ontario, and is really at a point where it is overwhelming the ability of Public Health to do case management and contact tracing, he says. Follow-up has already become much more cursory, which means contact tracing is going to be less effective at keeping a lid on cases, and will be contributing to the increase we’re seeing, says Hirji.

And that increase, he says, is coming in the younger age group. There has already been an increase in the number of cases in those younger than 20, because of school outbreaks, he says, adding he believes it’s starting at home with family members and spreading to children, who take it to school. 

While some areas have taken “drastic action” by closing schools, Hirji agrees with the province that children need to be at school, and that schools should be the last thing to close. Teachers are next up to be vaccinated, likely through Niagara Health, which could dedicate some clinic dates to educators, rather than having them book through the provincial online system, he says.

The next age group, the 20 to 39-year-olds, is also increasing, and is dominating the spread of infection.

They are a driver of the community increase, “because they’re working service jobs, and they’re working jobs where they aren’t able to stay at home.”

It’s no fault of their own that they are more at risk — it’s a matter of their work environment, he says.

The 40 to 59 age group, the parents of the younger people who are getting sick, is also trending up. 

The good news is that the number of vaccinations in the older age groups are having an effect, and we’re seeing that impact with cases in those age groups considerably lower.