Hamilton is ‘one step away’ from lockdown — but no one knows what triggers it

As Hamilton sits on the cusp of lockdown, there is no firm answer on what will trigger wide-scale closures.

That's the $64-million question for everybody ... When do you get to that stage of full lockdown again?" Hamilton's medical officer of health Dr. Elizabeth Richardson said at a city briefing Monday. Landing that is something that is very much being worked on at a provincial level."

Hamilton entered the red zone of Ontario's COVID-19 Response Framework on Monday after thresholds were dramatically lowered in the face of widespread criticism.

Red is just one step away from a full lockdown," said Mayor Fred Eisenberger. Nobody wants a full lockdown. It's the worst-case scenario. We're trying to balance between limiting the cases we have and trying to keep the economy and the city going as much as possible."

It's not clear what would get Hamilton to lockdown, which is the only level to have no stated metrics.

We don't want to see the kind of transmission that you can see in many places in the United States or in some other countries," said Richardson. We know the earlier you take action the more likely you are not to get there."

It's difficult to predict lockdown considering the other regions in red - Peel, York and Toronto - have much wider spread of COVID-19 than Hamilton and Halton.

All five regions have the province's highest weekly rates of COVID-19 cases per 100,000, but there is a vast range between them with Peel at 174.5 for Nov. 6 to Nov. 12 and Hamilton at 54.4.

Toronto was 102.5, York was 75.4 and Halton was 57.2.

We are, in my mind, still in another category than Peel or Toronto," said Dr. Dominik Mertz, associate professor of infectious diseases at McMaster University. The way it is currently framed, there is a wide range ... in the red. We will learn from that whether that's the right thing or not."

The disparity doesn't mean Hamilton and Halton don't belong in red, which has the tightest restrictions.

The move to the red zone category is an unfortunate but necessary measure in order to protect the health and well-being of everyone in our community," said Eisenberger. While we're in the red category, it's important we behave in a way that will ensure we don't end up having to implement additional restrictions."

Measures above and beyond the red zone - as was done in Toronto and Peel - won't be added to Hamilton for now.

With ... the red level that is a significant change ... in terms of the restrictions," said Richardson. We're not looking at more restrictions. Should the case numbers go up, we would quickly be looking at something else."

Numbers have been more stable after a surge that saw 185 new cases from Nov. 7 to 9. Hamilton reported 24 new infections Monday for a total of 371 active cases.

We haven't been on the right track for the last couple of weeks," said Mertz. It looks better over the last few days and I hope the trend is shifting but it's too early to call."

A number of metrics are still going in the wrong direction with the most troubling being deadly outbreaks in seniors' homes. Of 18 ongoing outbreaks, 13 are in long-term care and retirement homes. More than half are spreading.

Two more deaths were reported in long-term care Monday bringing the city's pandemic death toll to 67 or three per cent of cases. A woman in her early 60s and a man in his late 80s died Nov. 13 in the outbreak at Hamilton Continuing Care at 125 Wentworth St. S. where four have died.

There have been 18 deaths in 12 days at outbreaks in Hamilton seniors' homes from Nov. 2 to Nov. 13.

New outbreaks reported Monday include St. Peter's Residence at Chedoke, where one staff has tested positive at the long-term care home on the west Mountain, and at the Charlton Campus of St. Joseph's Healthcare. Six workers have tested positive at CTU central, which is a general internal medicine unit.

The per cent of tests coming back positive for COVID-19 has been steadily rising to 3.0 on Nov. 13 from 1.5 on Oct. 30, shows a report to the board of health on Monday.

The reproduction number shot up to 1.25 from 0.97 during that same period, which is significant because anything over 1.0 results in exponential growth of the virus.

By Nov. 8, public health was struggling with contact tracing to the point that only 27 per cent were told within one day compared to 66 per cent on Oct. 30. Delay is significant because the longer it takes to notify close contacts of cases, the higher the chances they transmit the virus to others. Public Health Ontario and the province have sent help.

It's unknown how much of a difference being in red over the next 28 days will make.

The main driver is private gatherings and that's not necessarily affected," said Mertz. I think that's a piece that's much more tricky from a policy perspective to address."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com