Twenty-one Ontario doctors have signed a joint letter to Premier Doug Ford, urging him not to issue a new lockdown this fall because of rising COVID-19 case numbers.

Daily numbers of new cases have risen dramatically in recent days, with Ontario recording 700 new cases of COVID-19 on Monday – the highest number of new cases recorded in a single day.

However, the 21 doctors who signed the letter to the premier say another provincewide lockdown—similar to what was in place in the spring—would not be helpful.

"We are writing this letter in support of the governments’ plan to use a tactical localized approach, rather than sweeping new lockdown measures, to deal with the increasing COVID case numbers in Ontario," the letter says. 

"Lockdowns have been shown not to eliminate the virus. While they slow the spread of the virus, this only lasts as long as the lockdown lasts. This creates a situation where there is no way to end the lockdown, and society cannot move forward in vitally important ways including in the health sector, the economy and other critically important instrumental goods including education, recreation, and healthy human social interactions."

Speaking on Newstalk 580 CFRA's "The Morning Rush with Bill Carroll" in Ottawa, CTV's infectious disease specialist Dr. Neil Rau—a signatory of the letter—pointed to two data points to consider when looking at the spread of COVID-19.

"We're reacting to increased aggregate case numbers, but the percentage positive is not really as bad as it used to be," he said. "We're testing more people, so we're finding more cases […] We're driving our numbers up, it's worse than it was in the summer, but it's not what it was last winter and life has to go on."

Monday's 700 cases in Ontario came from 41,111 total tests, for a positive percentage rate of 1.7 per cent. On April 24, the previous watermark of 640 new cases in a single day, the result came from 12,295 tests, for a positive percentage rate of 5.2 per cent.

Testing capacity was lower in the spring than it is now, and testing criteria has changed over time; however, Dr. Rau and the other signatories of the letter said the increasing case numbers are not leading to unmanageable levels of hospitalizations.

"In Ontario and other parts of the world, such as the European Union, increasing case loads are not necessarily translating into unmanageable levels of hospitalizations and ICU admissions," the letter says.

The letter also points to other health impacts linked to the lockdown.

"Hard data now exist showing the significant negative health effects shutting down society has caused. Overdoses have risen 40% in some jurisdictions. Extensive morbidity has been experienced by those whose surgery has been cancelled, and the ramifications for cancer patients whose diagnostic testing was delayed has yet to be determined," the letter states.

"Economic harms are health harms," Dr. Rau told CFRA. "It sounds horrible to say, but it's true. Health is wealth. We all know this."

LETTER POINTS TO DISAGREEMENT AMONG HEALTH PROFESSIONALS

Other Ontario health professionals have been arguing for increased restrictions as cases rise.

Last week, the Ontario Hospital Association released a letter signed by 38 health professionals which called for immediate restrictions to be re-imposed on non-essential businesses, such as gyms, dine-in restaurants and bars, nightclubs, and theatres. It also calls on restrictions on other places where people can gather, such as places of worship.

The letter from the OHA said regions where the speed of transmission was underestimated are “now facing the consequence of increased hospitalization rates, including a rise in intensive care unit (ICU) admissions and more deaths.”

Hospitalizations in Ontario have been increasing, but have not yet reached the same level that was seen in the spring.

According to data from the Ontario government, there were 128 people in hospital in Ontario with COVID-19 complications on Monday—the day 700 new cases were recorded—up from 65 a week before; however, on April 24—when 640 new cases were recorded—government data shows that there were 910 people in hospital. The peak for hospitalizations in Ontario came in May, when there were days when more than 1,000 people were hospitalized. That number steadily decreased from May through the summer before it began going up again in September.

Speaking on CTV Morning Live Ottawa, infectious disease specialist Dr. Abdu Sharkawy suggested temporary restrictions on gathering would help curb the spread of COVID-19

"We don't want to see our hospitals overwhelmed," he said. "We're still waiting for flu season and a whole bunch of other respiratory viruses to hit us and our capacity to be challenged. We don't want that to happen. We need everybody to try and simplify their lives and minimize anything that's non-essential."

Dr. Sharkawy said regions where cases are rapidly rising may need to impose new restrictions to get the spread of the virus under control.

"I think it's abundantly clear that, particularly in hot spots like Ottawa, Toronto and Peel region, the situation is not well controlled," he said. "Sometimes you need blunt instruments, even if they're temporary in nature, to make sure that you curtail the spread of this virus because it gets away from us a lot more quickly than many of us can anticipate sometimes."

Dr. Sharkawy suggested hot spots follow the lead of Quebec, which imposed harsh restrictions on three areas in the province, including Montreal and Quebec City, banning private gatherings and closing bars and restaurant dining rooms.

"I think we should do it now," Dr. Sharkawy said of Ontario. "I think we all need to adopt an attitude and an approach that recognizes that we have to do what's absolutely necessary to keep everybody safe."

FULL LETTER FROM ONTARIO DOCTORS TO THE PREMIER

Dear Premier Ford,

We are writing this letter in support of the governments’ plan to use a tactical localized approach, rather than sweeping new lockdown measures, to deal with the increasing COVID case numbers in Ontario. Lockdowns have been shown not to eliminate the virus. While they slow the spread of the virus, this only lasts as long as the lockdown lasts. This creates a situation where there is no way to end the lockdown, and society cannot move forward in vitally important ways including in the health sector, the economy and other critically important instrumental goods including education, recreation, and healthy human social interactions.

In Ontario the increase in cases at this time are in people under 60 years of age who are unlikely to become very ill. At the peak of the pandemic in Ontario in mid-April, 56% of cases were in ≥60 year olds, now in Sept only 14% of cases are in ≥60 year olds. In Ontario and other parts of the world, such as the European Union, increasing case loads are not necessarily translating into unmanageable levels of hospitalizations and ICU admissions. This is not a result of a lag in reporting of severe and fatal cases. While we understand the concerns that these cases could spill into vulnerable communities, we also need to balance the actual risk. As the virus circulates at manageable levels within the community, we need to continue the gains we have made in the protection of the vulnerable in long-term care and retirement institutions, and continue to educate other people about their individual risk, so that they can observe appropriate protective measures.

Lockdowns have costs that have, to this point, not been included in the consideration of further measures. A full accounting of the implications on health and well-being must be included in the models, and be brought forward for public debate. Hard data now exist showing the significant negative health effects shutting down society has caused. Overdoses have risen 40% in some jurisdictions. Extensive morbidity has been experienced by those whose surgery has been cancelled, and the ramifications for cancer patients whose diagnostic testing was delayed has yet to be determined. A huge concern is the implication of closure of schools, and the ongoing reluctance we have seen in the large urban centers of sending children back to the classroom due to safety concerns. Global data clearly now show that children have an extremely low risk of serious illness, but they are disproportionately harmed by precautions. Children’s rights to societal care, mental health support and education must be protected. This cannot be achieved with ongoing or rotating lockdown.

The invitation and involvement of other health experts to advise the government’s response beside individuals in Public Health and Infectious Diseases in addition to leaders in the business, securities and arts communities is essential. We also call for increased open debate, in the public forum, that hears voices from outside the medical and public health communities, in order to consider all points of view from society. This is a fundamental principle upon which democratic societies are built. All stakeholders should have an equal right to participation in public discourse when it comes to setting such fundamental and sweeping societal interventions.

All have the right to feel their voices have been heard, and moreover to ensure factual credible data is openly debated, in contrast to the personal and political slants that have had apparent significant impacts on the management of the virus to date. Our society has borne enormous pain over the past 6 months. It’s time to do something different.

Sincerely,

Jane Batt MD, PhD, FRCPC. Respirologist, Associate Professor, Department of Medicine, University of Toronto

James Bain MD, MSc, FRCSC. Plastic Surgeon, Professor of Surgery, McMaster University

Mahin Baqi MD, FRCPC. Infection Prevention and Control and Infectious Diseases Physician

Marcus Bernardini MD, FRCPC. Gynecologic Oncologist, Associate Professor, University of Toronto

Sergio Borgia MD, MSc, FRCPC. Infection Prevention and Control and Infectious Diseases Physician, Assistant Clinical Professor, McMaster University

Peter Cox, MBChB, FRCPC, DCH(SA), FFARCS. Critical Care Physician, Professor, Department of Anaesthesia, University of Toronto

James D. Douketis, MD, FRCPC, FCAHS. Haematologist, Professor of Medicine, McMaster University

Philippe El-Helou, MD, FRCPC. Infectious Diseases Physician, Associate Professor, Department of Medicine, McMaster University

Martha Fulford MD, FRCPC. Infectious Diseases Physician, Associate Professor, Department of Medicine, McMasterUniversity

Shariq Haider MD, FRCPC. Infectious Diseases Physician, Professor, Department of Medicine, McMaster University

Stephen Kravcik MD, FRCPC. General Internist, Associate Professor, Department of Medicine, University of Ottawa

Nicole Le Saux MD, FRCPC. Infectious Diseases Physician, Professor, Department of Pediatrics, University of Ottawa

Paul MacPherson PhD, MD, FRCPC. Infectious Diseases Physician, Associate Professor, Department of Medicine, University of Ottawa

Neil Rau MD, FRCPC. Infectious Diseases Physician and Medical Microbiologist, Assistant Professor, Department of Medicine, University of Toronto

Susan Richardson MD, FRCPC. Medical Microbiologist and Infectious Disease Physician, Professor Emerita, Department of Laboratory Medicine and Pathobiology, University of Toronto

Coleman Rotstein, MD, FRCPC, FACP, FIDSA. Professor of Medicine, Division of Infectious Diseases, University of Toronto, Attending Physician, University Health Network

Rob Sargeant MD, PhD, FRCPC. General Internist, Associate Professor, Department of Medicine, University of Toronto 

Nick Vozoris MD, MHSc, FRCPC. Respirologist, Assistant Professor, Department of Medicine, University of Toronto

Thomas Warren MD, FRCPC. Infectious Diseases Physician and Medical Microbiologist, Assistant Clinical Professor (Adjunct), Department of Medicine, McMaster University

Yvonne Yau, MD FRCPC. Medical Microbiologist, Assistant Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto

George Yousef MD, PhD, FRCPC. Anatomic Pathologist, Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto