Health experts, politicians question Ford cabinet's understanding of COVID modelling

Ontario waited an extra week to implement a stay-at-home order to see if the modelling that predicted overflowing hospitals was coming true, according to the solicitor general.

The remarks from Sylvia Jones added to an explanation that Premier Doug Ford and Chief Medical Officer of Health Dr. David Williams had given Wednesday when they introduced the stay-at-home order and were asked to justify why they hadn't done so a week prior, when they announced weaker "shutdown" restrictions.

The comments also added fuel to concerns from opposition politicians and health experts that Ontario's decision-makers don't understand and don't trust the coronavirus modelling information provided by provincial advisers.

In a radio interview Thursday morning, Jones was asked about the delay in implementing the stay-at-home order.

"Over the weekend we saw, frankly, that [the shutdown] wasn't sufficient and our ICU beds were filling up, we cannot continue to put our hospitals under that type of strain, both in terms of inventory of intensive care beds, as well as the health human resources, and the toll that comes with families who have members in those ICU beds," Jones said.

The interviewer, CBC's Robyn Bresnahan, replied that that sounds like an "Easter experiment" and asked why the province needed to wait given that the province had been warned by its own experts and others that this scenario would come to pass.

"We wanted to make sure that the modelling was actually showing up in our hospitals," Jones replied. "We've seen that now. As I said, over 500 ICU beds have COVID positive patients in them."

"So modelling numbers and actually what we're seeing in the hospitals are not the same," she continued and Bresnahan pressed her on what she meant by that.

"I mean, that modelling numbers are by their very nature prediction," she replied, adding that Ontario is now seeing those predictions "on the ground."

Ontario's modellers have warned for weeks that ICUs would become overloaded this spring. Six weeks ago, the modelling warned that ICU occupancy levels, which remained high but had reduced as a result of the previous restrictions, would pick up again as a result of the variants of concern spreading across Ontario.

At the time, co-chair of the provincial science table Dr. Adalsteinn (Steini) Brown agreed with a reporter's assessment that his presentation was "predicting a disaster" that would occur as the province was moving to lift restrictions while the more transmissible COVID variants of concern were taking hold. But, he stressed the ICU numbers and other outcomes would depend on how effectively the province handles public health measures in the weeks ahead. His presentation included a warning of a potential high-transmission scenario that would see the numbers climb steeply, which has come to pass.

Four weeks ago, the modelling was more certain: it predicted a rise in numbers under any scenario, including between 400 and 600 COVID-19 patients in Ontario's ICUs in early April. Ontario reached and has now exceeded 500 cases.

Last week, the modelling was presented on the same day the shutdown was announced and had been presented to cabinet the day before. It was unequivocal: ICU numbers would rise to 800 COVID-19 cases by late April under any scenario, a level that imperils the hospital system's ability to care for the sickest Ontarians. Whether it got worse from there would depend on the public health measures in place.

The province doesn't rely only on modelling. Individual intensive care physicians and health-care groups including the Ontario Hospital Association (OHA) had been warning with increasing urgency that the variants of concerns were driving ICU admissions beyond on a manageable level.

On the day the latest shutdown order was announced, OHA CEO Anthony Dale told QP Briefing, “This is the single biggest crisis in the history of our modern health-care system,” and that live-saving care was already being delayed.

When Ford announced the stay-at-home order on Wednesday, he said it was because the ICU situation had worsened beyond what he'd been previously told.

"These variants have taken off even beyond what they told us and the second I found out yesterday, immediately, I asked them to start writing up the orders," he said.

Williams went on to say that the hospital and ICU rate of growth had accelerated since the week prior.

At a media briefing Thursday, Associate Chief Medical Officer of Health Dr. Barbara Yaffe elaborated on that: she said the rate of increase of cases and hospitalizations picked up after the shutdown was announced so the province could not afford to wait until it could have an effect before taking further action.

Asked about Jones' comments, Yaffe declined to comment on them directly but said it's not a good idea to wait for ICU numbers to rise before taking action.

"Certainly we take the modelling very seriously," she said. "I don't want to argue with the solicitor general but I would just say we can't wait to see ICU numbers go out. That is the very last indicator prior to death and what we're trying to do is keep people healthy and prevent infection."

Dr. Noah Ivers, a family doctor and researcher affiliated with the Dalla Lana School of Public Health and Women's College Hospital, told QP Briefing he believes the government hasn't trusted the modelling so far. When the scenarios outlined in the models don't come to pass, it's generally because the public health measures put in place have helped prevent them, he said.

"Invariably, the circumstances change. Ideally, they change so that by design, the models can't come true," he said. "Then when somebody looks back and says, 'Hey, that never came true,' they forget to add the obvious reason why didn't come true, which is that we took action to prevent it from coming true."

Waiting, as Jones described, for the actual ICU numbers to rise to the dangerous level predicted by the modelling means the province is acting too late, rather than acting decisively based on the trends the modelling shows, Ivers said.

"We're a month late," he said. "Hundreds of people are going to die because we're doing this a month late."

Ivers said it's a "huge freaking problem" for a government not to trust its own modelling and the scientists behind it. "What concerns me is that there is a lack of trust, clearly, between the advisers and the decision-makers."

Meanwhile, opposition politicians lambasted the Ford government for its delay in accepting that ICUs were in crisis, with Liberal Leader Steven Del Duca going as far as questioning the premier's "intellectual capacity."

Del Duca said Ford should have sought out advice beyond what Williams was giving him if Williams' advice didn't align with that of the science table modellers and other experts issuing warnings.

"What we've seen consistently throughout this pandemic is that that level of curiosity, that level of intellectual capacity, seems to be completely absent in Doug Ford," he said at a media conference Thursday.