HEPL blog series: Country Responses to the Covid19 Pandemic

Ontario’s response to the coronavirus pandemic

 

Greg Marchildon[1][2]
Sara Allin[1][2]
Karen Born[1]

 

[1] Institute of Health Policy, Management and Evaluation, University of Toronto
[2] North American Observatory on Health Systems and Policies

 

 

Background and Scope

With 39% of Canada’s population (14.7 million residents), Ontario is home to the country’s largest city, Toronto, and its national capital of Ottawa. Like all provincial governments in Canada, the Government of Ontario has been largely responsible for determining the public health interventions as well as most other public policy measures in response to the coronavirus pandemic. Given the size (7.8 million) and the density of the population in southern Ontario that emanates from Toronto, along with a very busy and populous border with the United States and Canada’s busiest international airport, the provincial government faced perhaps the greatest challenge of any government in Canada in containing the spread of coronavirus. On 21 April, the provincial government released projections suggesting that the peak would be at 20,000 cases total, and provided data showing that the majority of deaths are occurring in long-term care homes, particularly hard hit by COVID-19. Recent estimates suggest that 84% of total deaths from COVID-19 in the province were in LTC homes (including retirement homes), which is similar to Quebec but much higher than in Alberta and British Columbia.

As of 5 May, the province’s 129.3 cases per 100,000, though much higher than British Columbia (43.6) was slightly lower than in Alberta (132.8) and substantially below the rate in Quebec (382.8).  Ontario’s testing rate per 100,000 (2,333.3) by this date was average by Canadian standards but considerably lower than Quebec’s rate (2,816.0) and Alberta’s (3,747.4). Ontario’s reported death rate of 9.7 per 100,000 population on 5 May was the second highest in Canada, but still considerably below Quebec’s death rate of 26.8.

 

Public Health Measures

On 25 January 2020, Ontario had its first case of COVID-19. For approximately six weeks, the provincial government actively monitored the situation with the province’s Chief Medical Officer of Health (CMO) providing twice weekly briefings beginning on 20 February. By the second week of March, the provincial government began to intervene more aggressively in terms of enforcing physical distancing. This included announcing the closure of schools on 12 March, restricting mass gatherings and locking down provincial jails on 13 March, and the closure of restaurants, bars, churches, gymnasiums and similar facilities on 16 March.

On 17 March, the provincial government declared a time-limited state of emergency under Ontario’s Emergency Management and Civil Protection Act that allows the government to restrict travel, procure necessary goods and services, and close any public or private place.  This was followed by the closure of all provincial parks (18 March), the closure or restriction of numerous non-essential government services (19-22 March), and measures to prevent price gouging on necessary goods including non-prescription medicines, disinfecting agents, personal hygiene products (including toilet paper), masks and gloves.

To the date of this blog, the provincial government has not used the state of emergency to prevent individuals from entering Ontario from another province or territory in Canada, or prevented residents from leaving Ontario. While numerous steps have been taken to protect the safety of employees and travelers, public transportation continues to operate in all cities.

 

Socio-Economic Measures

In the second half of March, the government enacted financial and other measures to support residents whose jobs have been affected by the pandemic. These included protected leave for employees in isolation or quarantine, or for those caring for children or other relatives, deferring payments on student loans, and providing breaks on provincially-controlled electricity rates. Employers received relief from the provincial government in the form of subsidies and tax cuts. The province also invested CA$200 million in social service relief funding to support municipalities and non-government organizations to provide essential services such as shelters, food banks, and emergency centres. Financial support was also provided to Indigenous residents of Ontario that included paying for health care professionals and critical supplies to reach remote First Nations communities located in the sparsely populated northern regions of the province.

On 3 April, the Ministry of Health and Public Health Ontario released modelling projecting a series of scenarios with and without public health interventions of COVID-19 spread and deaths. It highlighted that public health measures prevented deaths, but that expansion of ICU capacity from 410 existing beds province-wide to 1,200 was necessary to meet the estimated surge of roughly 80,000 COVID-19 cases in the province. On 14 April, the state of emergency was extended to 12 May allowing the provincial government to keep closed all non-essential workplaces and communal settings such as parks, as well as prohibit social gatherings of more than five people.

 

Reflections on the Ontario Response

Given the density of population and close proximity and border to New York state with the most COVID-19 cases globally, Ontario has fared reasonably well to date.  This is in part due to the rapid response of the provincial government, particularly the social distancing and other measures taken in mid-March. However, there are two areas which have posed major challenges to provincial authorities: 1) the low rate of testing (and the policies surrounding testing); and 2) preventing and mitigating COVID-19 spread in LTC facilities.

Widespread and effective testing mechanisms for COVID-19 have been a critical component of successful country responses. Due to limited testing materials such as swabs, as well as limited laboratory capacity, Ontario has rationed testing and even designated COVID-19 assessment centres did not offer widespread testing. The lack of robust data on COVID-19 spread has hampered the ability for policy-makers to make evidence-informed decisions regarding when to ease social distancing and other restrictions.

Ontario was slow to respond to the COVID-19 crisis in the province’s LTC sector, especially as compared to British Columbia which had early outbreaks in LTC.  It wasn’t until April 15 that the Government of Ontario announced temporary regulatory changes that restrict staff from working at multiple LTC facilities (effective April 22), though some staff are still exempt. Shortages of staff, as well as personal protective equipment (PPE) in LTC and limited testing have on the one hand led to actions involving the courts to compel LTC facilities to provide PPE to its staff, and the government to change testing criteria to prioritize LTC staff and residents (even those who are asymptomatic).  On 22 April, Premier Doug Ford announced that the Canadian Armed Forces would deploy military personnel to a small number of the most affected LTC facilities to fill in human resources gaps. This follows Quebec, which requested a similar deployment a week prior.  Further, some hospital resources and staff have been redeployed or extended to support LTC needs, especially given the lower than anticipated surge of COVID-19 patients in acute care settings.

Ontario is the largest province in Canada by population and economy. There are tremendous pressures to ease restrictions put in place in mid-March and stage a gradual return to institutions, workplaces and business in order to reduce the impact on the provincial and national economies. The general exit strategy was released on April 27 but no details have been determined yet, in contrast to other provinces where the measures are already starting to be relaxed (e.g., in Alberta and Saskatchewan).  The phased approach to recovery is contingent on reductions of new cases, information ascertained by improved testing, as well as a reduction in COVID-19 spread in hot spots such as LTC. Whether additional resources, capacity and other measures are able to address these urgent priorities is yet to be seen.

Health Economics, Policy and Law serves as a forum for scholarship on health and social care policy issues from these perspectives, and is of use to academics, policy makers and practitioners. HEPL is international in scope and publishes both theoretical and applied work.