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Not an open and shut case

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Both Ontario and Toronto hit record numbers of COVID-19 cases this week, yet Doug Ford, it seems, wants the shuttered restaurants, bars, gyms, and cinemas to reopen. Is that really wise?

Nobody much cares what I think about it, but I can’t help thinking about it anyway. So now I’m inflicting my thoughts on you.

A leopard and his spots

Ford’s dilemma is that he is, of course, a Conservative, and therefore very much inclined to support business and disinclined to support government spending as a solution. So if businesses are suffering, he’d much rather allow them to reopen and earn money directly from citizens than to compensate them for loss of business with government funds.

Ford’s government has generally prioritized our ability to be consumers over our ability to gather with family and friends. Or rather, we are only allowed to gather with family and friends if we are also contributing to the economy.

This results in absurdities such as: A mask-required, no dance, no supper, outdoor wedding to be held in a backyard in low-incidence Timmins being cancelled when the province decreed that private events were to be limited to 25 people outdoors, 10 indoors. But paying for an indoor wedding of over 100 guests in high-incidence York region was allowed to proceed. And then… At least 44 people diagnosed with COVID-19 after large wedding in Vaughan

Testing, testing

Not enough of it is being done, results aren’t being turned around fast enough, the backlog persists. So the data’s not great. What data they have, the Ontario government is currently trying to spin to make the case that a continued shut down isn’t necessary.

Take what I heard on CBC Radio this morning, that only 2% of cases are linked to restaurants, 5% to gyms. Sounds like hardly anything, right? But that’s not the whole story! They were only talking about outbreaks; not all cases. I’ll let Ottawa Public Health fill you in:

Furthermore, their data was for a 13-week period that included 4 weeks in which all these establishments were closed. As one might imagine, there aren’t a lot of communicable disease outbreaks that occur in empty gyms, restaurants, bars, and cinemas. So that makes that supposedly tiny percentage even less valid.

Who’s on first?

The Atlantic had this fascinating (though long) article, This Overlooked Variable Is the Key to the Pandemic, which makes the case that, because 20% of people cause 80% of the infections, contact tracing efforts should focus more on finding out whom the person caught the virus from (backward contact tracing) and less on warning people whom that person might have been in contact with since becoming infected (forward contact tracing):

Even in an overdispersed pandemic, it’s not pointless to do forward tracing to be able to warn and test people, if there are extra resources and testing capacity. But it doesn’t make sense to do forward tracing while not devoting enough resources to backward tracing and finding clusters, which cause so much damage.

Zeynep Tufekci

I don’t believe Ontario has made this switch in focus which, given their testing challenges, sounds like it would make sense. And, it would also give them actual solid data on where people are becoming infected.

Though they might not like the answer.

Hell’s kitchen?

The restaurant industry feels unfairly targeted by the shut downs and hey, it’s an industry close to my heart. But now that we know that COVID-19 can be transmitted through airborne routes, we have to face the fact that restaurants (and bars) have some inherent dangers that cleaning and six-feet distancing simply can’t overcome.

People sit in there for an hour or two, unmasked most of the time, talking and laughing. So you’re definitely at risk from anyone at your table. But you’re also at risk from people at other tables, because aerosols can float around much farther than six feet, and stick around after they leave—particularly in establishments without great ventilation.

Example (which also speaks to the benefit of masks!):

That doesn’t mean I think that all restaurants in all of Ontario should be closed. I do believe in a regional approach. Where community incidence is low, so is the likelihood of that special combination of factors that can result in you being infected from strangers at distant restaurant tables.

But when per-capita community spread is greater than a certain amount—and I do think it would help if the government set a clear target for what that is—they need to close, and stay closed, until the numbers go down again.

It would also help if the provincial government would give these shuttered businesses the financial help they were promised, but has so far yet to materialize.

Working it out (in a gym)

Not being a gym person, I’m ill-equipped to speak about whether closing them is justified. Certainly, Ontario had that infamous spin class outbreak: 69 people infected in COVID-19 outbreak at Hamilton spin studio, Spinco—another case that points to airborne transmission, since everyone was six feet apart. But, also maskless and breathing really hard for an hour.

So, couldn’t gyms solve a lot of their problems by making people wear masks? Of course, I realize it’s not pleasant to be masked when doing an activity that makes you sweaty and hot, but if the alternative is no gym…

I also agree with the argument that while group aerobics are clearly risky, other types of workouts aren’t as much. Small numbers of people moving around to distanced weight equipment, masked while moving, and maybe even when lifting… to me is not wildly different from people moving around a store. Or, one-on-one training, especially if the trainer is masked the whole time.

So I can see a case for coming up with different rules that allow gyms to reopen instead of keeping them shuttered. Especially as there is a health benefit to exercise that not everyone can get at home or outdoors (especially in winter).

Going to the movies

Ah, poor cinemas. Even where open, things aren’t going to great, given that Hollywood doesn’t want to release its big movies now.

But without that supply of blockbusters, I think theatres probably aren’t that dangerous—how many people are going to go anyway? Surely the attendance will be rather low for the foreseeable future. And there’s also the fact that you can wear a mask there, except when eating popcorn, which most people don’t do for the full 2 hours. And that talking is discouraged.

Going to concerts

Concerts? When did those reopen?

Well, they haven’t, except for a few drive-in and virtual events. And I don’t see how they can, given that the economics of them doesn’t support distancing (masks can only do so much).

So as we feel sympathy for those industries having to repeated open and close, let’s remember those that have been dark since March, with no end in sight until the vaccine rolls out.

Lessons from Europe… and Manitoba

Of course they have time to change their minds, but the Ontario government’s idea seems to be to reopen and accept that some 7000 Ontarians a week are going to continue to get infected with this disease, and just hope that it doesn’t increase to 14,000, 28,000…

Only, it’s not like they haven’t already tried this elsewhere.

Morris said Toronto is in danger of following in the footsteps of countries in Europe, which tried to tolerate having a large number of cases.

“They go on for a certain period of time and it seems rather stable, and there’s no new admissions to hospital or the number that do go to hospital seems rather acceptable, and then it takes off.

“That pattern has happened repeatedly,” said Morris, citing France, Switzerland, Ireland, Belgium and Germany as examples. [Belgium, for example, has closed all non-essential businesses and banned family gatherings!]

Ford, Tory want to lift restrictions on restaurants, bars after 28 days, but epidemiologists warn this could have tragic consequences (Toronto Star)

Next door, in Winnipeg, Manitoba, they are cancelling “elective” surgeries and diagnostic again, because they just don’t have the hospital capacity. (What’s been the effect of Ontario having done that in the spring? Now hospitals are seeing many more patients with advanced cancers.)

It just doesn’t look like time to fully reopen, to me.

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