Bruce Arthur: Doug Ford may yet have to make the hardest decision of the pandemic so far — shutting the province down again

Doug Ford's real strength as a politician is the big-guy bluster, the I'm-fed-up. The premier has employed it during the coronavirus pandemic more than once. No price gouging! Ease up, landlords! More testing! That last one has been a recurring feature in the last couple months.

But pretty soon Doug may actually have to make the big call, and it will be hard. Ontario's COVID-19 case counts are up. Testing just dropped precipitously. And none of that is a reflection of the expected increase in viral spread from the partial reopening of businesses that started late last week.

So in the coming days, if it doesn't improve and in fact gets worse, Doug is going to have to make the hardest decision of the pandemic so far: he'll have to try to lock things back down. And the experts are worried.

We're in a bad place," says epidemiologist Dr. David Fisman, of the University of Toronto. I think things are going wrong."

This is really problematic when you factor in how our testing isn't at full capacity," says epidemiologist Dr. Nitin Mohan, who teaches public and global health at Western University, and who co-founded a public health consulting firm called ETIO.

It's going to be so hard to walk this back," says epidemiologist Dr. Lauren Lapointe-Shaw, an associate professor at the University of Toronto.

I almost feel like we're back to March," says epidemiologist Dr. Ashleigh Tuite, also of the University of Toronto.

Last week, Doug got to open up golf courses and marinas and private campgrounds and every store that isn't in a mall: safely, mind, don't do it unless it's safe.

It felt like a lurch forward at the time, coming so soon after the reopening of curbside pickup. Ontario only dropped below 300 daily new coronavirus cases once, on May 10, when the five-day rolling average was 328, and Ontario had largely controlled the epidemic in long-term-care homes.

And now Ontario is at 427, 394, 413 and 404 cases in the past four days. It is seeing a spike in community cases, largely but not only in the GTA. Fisman pegs the surge to Mother's Day weekend, near enough, when the premier broke the rules and others may have, too.

This stuff should start hitting hospitals over the next week or so," says Fisman. I suspect they're going to have to lock down again, because we haven't sealed the deal. What's bizarre is it's Ford himself who said road map, not calendar.

This is not exactly a world-class effort here."

Meanwhile, the province is aiming for 20,000 tests per day, and the average in the last five days was less than half that. The province completed testing long-term-care homes last week, and Friday they finally expanded the narrow testing criteria at assessment centres that had pushed so many people away. But people didn't come to the centres, and not enough tests are happening anywhere else.

So there was Doug, blustering that he expects a plan that includes community and surveillance testing by next week. Which would be over a week after the start of reopening, which presumably should have been accompanied by a plan.

Why was phase one even allowed to happen if our testing wasn't where it needed to be?" says Mohan. And if we're in the 600s (daily) do we pull back on phase one? I think that's the fear you're seeing from the critical care physicians, and (epidemiologists), is that we're worried that all the measures that we've done the last two months might be for naught now. I'd like to be wrong."

There may be damage. We are beset by increasing impatience, an accumulation of enclosure, mounting economic damage, bills coming due in every sense. Has the government built up enough trust to actually make people comply with a return to a lockdown?

Even if we have an uptick of 2-3 per cent that aren't abiding by the recommendations, with exponential math, you could easily see case counts in the 600s pretty quickly," says Mohan.

Like a dad at a party, Doug has warned he will close it down, if he has to: he has blustered, I will not hesitate. But he has to be prepared to actually do it, and soon.

If it was up to me I would not have reopened," says Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto, and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network. He points to a lack of capacity to test, contact trace and isolate cases. It is clear that contact tracing alone has problems.

I'm not a politician and I'm not a public health physician, so it's easy for me to say that," says Morris. But with all the information that I know, including the health system, epidemiology, and looking at successful jurisdictions around the world: they completed their epidemic curve. They go up, they get it down, they have gradual reopening, and when they have embers, they find them and stamp them out.

We never went right down. And we opened up probably because of impatience, but there may be other reasons I'm not aware of."

There is no way to look at these numbers and say, it's probably nothing," says Mohan. All of our policy, every measure, is based on numbers. We can't leave our community's health to guesswork right now.

I'm very sensitive to the potential impacts of an economic downturn. But if we want any shot of redeeming successes that we've had prior to the pandemic, we have to control the virus. That's our only shot. Controlling our case counts, getting them really low, having adequate testing, means our economy comes back strong."

Hopefully, it's a Mother's Day blip, and the numbers drop back down. Hopefully, Ontario actually gets its act together. But right now it feels like the province is at a tipping point, and the premier may have to make the call. Nobody wants to go backwards. But we might not have a choice.

Bruce Arthur is a Toronto-based columnist for the Star. Follow him on Twitter: @bruce_arthur