Delayed lockdown could result in 10,000 additional COVID-19 cases in Ontario
The Ontario government's decision to delay the coming provincewide lockdown to Boxing Day will likely result in 10,000 cases of COVID-19 that could have been avoided, new projections reveal.
Pandemic modelling by Ryan Imgrund, a biostatistician working with several public health units, shows that by implementing a lockdown Dec. 26, instead of this past Monday, Dec. 21, 10,000 more people will likely become infected with the virus over the four weeks ending Jan. 23, the date the province says the coming lockdown will end.
And that means more people ending up in already-crowded hospital ICUs and as many as 200 more deaths, assuming current case fatality rates remain unchanged, experts say.
We know the majority of those Ontarians who are going to end up dying are going to be older adults," said Dr. Samir Sinha, director of geriatrics at Sinai Health System and the University Health Network. Right now, we don't actually have a hospital system, especially in places like Toronto, that have any spare capacity. We've already been delaying or cancelling elective procedures and surgeries."
On Sunday, sources within the Doug Ford government began signalling that the province would be locked down on Christmas Eve amid calls from hospitals across the GTA urging stricter public health measures. But on Monday, the premier said the lockdown would now take effect Dec. 26 to give businesses an opportunity to get ready.
We can't do it overnight and leave these people with inventory, especially the restaurants with food inventory," Ford told reporters during a press conference announcing the lockdown.
In conducting his modelling, Imgrund created two scenarios: the first looks at how the virus likely would have spread if the provincewide lockdown had begun at 12:01 a.m. on Monday Dec. 21; the second assumes the lockdown begins at 12:01 a.m. Dec. 26, as announced by the province.
He also assumed the virus's reproduction number at the beginning of each scenario was the province's current value of 1.05, meaning for every infectious person, 1.05 people will become infected. Then, after seven days of lockdown, the reproduction number in both scenarios is assumed to drop to 0.85 to reflect the amount of time it takes for symptom onset, COVID testing and getting a result.
A reproduction number of 0.85 was assumed because it is close to what other jurisdictions, such as Alberta and Quebec, saw after initiating provincewide lockdowns. In essence, it is assumed lockdown has the same effect in both scenarios.
The modelling shows that in the first scenario with the lockdown beginning on Dec. 21 new cases continue to climb until Dec. 28, where they peak at 2,398, before heading on a downward trajectory.
Under the second scenario, Ontario's current plan to initiate lockdown on Dec. 26, new cases continue to climb until Jan. 2, 2021, peaking at 2,459.
Imgrund noted that the model is conservative, because it does not assume post-holiday surges in new cases that Ontario saw after other holidays such as Labour Day and Thanksgiving.
It's assuming, and I think falsely, that Dec. 25 won't cause more cases, because people are going to gather," he said.
Why Ford would not start the lockdown earlier is a mystery to me," said Imgrund. I think sometimes we get so caught up with, oh look it's just an extra five days.' But we don't see the long-term effects of these short-term changes. There was no focus on the distant future. There was only focus on the immediate future and what impact that would have on retailers and family gatherings."
Sinha said procedures and surgeries are already being cancelled at Toronto hospitals due to a lack of capacity. He used the example of a 92-year-old female patient who recently came in to his hospital and had to wait more than 72 hours for a hip replacement, a procedure that ideally should be done within 24 hours.
Every single day you wait to do their surgery, that significantly increases their chance of dying in the end," he said. Every day that that lady was getting her surgery delayed was basically hastening her mortality. Those are numbers you're not going to see in the overall statistics right now around what the consequences of COVID are, because you're just hearing about 10,000 potentially more cases that we've allowed to happen."
Dionne Aleman, a University of Toronto professor and an expert in pandemic modelling, said it's hard to know if a lockdown of an extra five days would really change people's behaviour so close to Christmas.
People who really need immediate gifts that are shopping in person, they're all just going to flock to whatever store happens to be open," she said, adding that growing case numbers in Toronto and Peel, which have been in lockdown since Nov. 23, suggest that many people aren't following public health guidelines. I don't think asking people to change their social behaviour at this point is really going to do anything."
Instead, Aleman said lockdown restrictions need to be tightened, such as work-from-home orders and closures of all non-essential businesses for in-person dealings.
It really has to be from the top down with a heavy level of enforcement."
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca