Ontario Coronavirus Futures

Today’s disturbing Ontario numbers – 380 new cases – have to be understood in the ‘more testing’ context, obviously wider testing is going to uncover newer/more cases. What’s ALARMING about the number isn’t so much the size, as the fact that the test positive rate was so high.

So a lot has happened since I last wrote about the situation 5 days ago. Ontario has managed to ramp testing up to ~6000/day (from ~2000/day), and the backlog of testing has basically been eliminated. Presumably, we are now able to start testing some of those people who were not being tested before because their test results wouldn’t change the actions we take, e.g. returning travelers (I’ve personally heard reports that such people were not being tested). I’m still keeping track of Ontario, Toronto, Canada, California, and New York in a spreadsheet.  Pictured is the super fancy new interactive map of Canada that’s on the Canada COVID page as of two days ago, you can actually “play” it to see cases rise over time, which is pretty cool.

Today’s disturbing Ontario numbers – 380 new cases – have to be understood in the ‘more testing’ context, obviously wider testing is going to uncover newer/more cases. What’s ALARMING about the number isn’t so much the size, as the fact that the test positive rate was so high: 5.84% versus a previous level of around 4%. Obviously the population being newly tested is somehow higher risk than the populations we’ve been testing to date, which I think does make a little bit of sense for returning travelers who were expressing symptoms. In fact, it’s kind of surprising those wouldn’t be even higher. But that’s just one possible group of people who might be getting tested now, and honestly, all of this is mere speculation. The reality is that increased testing is going to show increased cases, and this is likely to continue until nearly all symptomatic, historical (meaning: we were alerted to them, but didn’t do a test because they were scarce) cases are confirmed. I estimate that’ll take many days to work through those kinds of cases, so I expect to see Ontario numbers remain at this elevated level for a while, perhaps a week, plus or minus a week? So hard to know, it sucks that Ontario has never reported presumptive positives / probable cases.

Once we’ve worked through that backlog of untested cases, presumably we’ll get back to data where we can try to understand the continuing community transmission again. I imagine Ontario Public Health itself is tracking community spread vs close contact vs travel-related cases, but they are no longer making that info public (and even before today’s change in their reporting, we’d only get that data for about half of cases). In the meantime it’s going to be quite difficult for us to tell if Ontario’s shutdown measures are actually working – we were expecting that this week the percentage growth numbers would finally start trending down, but that will now be masked by the testing boost, so without seeing the breakout, it’s going to be hard to tell.

Anyway, I’ve also been reading a lot more about what the future will be like, and I found this amazing essay on Medium: Coronavirus: the hammer and the dance, which goes into huge amounts of detail about why we’re suppressing rather than just distancing or doing nothing. Long about the 3/4 mark, it actually gets into “the dance”, which is the phase where we open back up, but selectively, letting some kinds of activities happen, doing a lot testing and isolating, and generally trying to keep R0 less than 1. Because we have to keep it contained, subexponential, since hospitals cannot hope to treat epidemics – even the small scale epidemic we’re facing now is going to be a considerable challenge for the health care system, though I continue to predict that we’ll be under the capacity here, do to our fairly quick action. Anyway, please go read the essay in full, I’ll wait, I promise it’s worth it.

Probably the most interesting thing in the whole essay is Chart 16 (click on it here for a bigger version), which is FAKE, i.e. those numbers are all made up as an illustrative example. But we can hope eventually to have real numbers for it and to use something like that to decide what’s possible to open up and what’s not once we’re in the dance phase.

Summing up my thoughts for Ontario Coronavirus Futures:

  • I’m revising my estimate for total cases in this hammer period (i.e. through the middle of May or so, see point below) up to 3-5k. With a small chance that numbers over the next week cause that estimate to double or triple again, of course. It’s already about double what I was projecting we’d end at in previous posts, so it’s quite likely that I’m *still* being unreasonably optimistic…
  • We’ll be in the hammer/shutdown for a total of 8 +/- 2 weeks, and we’re basically at the end of Week 2 now.  So 6 more weeks, through May 11th, at least. We’d get out early only if our numbers are smaller than above, AND public health decides that we’re going to be *really good* at the dance, which doesn’t seem very likely to me. Longer seems more plausible if the numbers are bigger or we’re still very uncertain about what is effective.
  • I expect that Ontario will decide that restarting school when we open is both too risky and not worth it, given that only about 1 month remains anyway, so school is likely to remain canceled. Presumably, there are already a lot of educators and school boards that are talking about what they will do about student grades for the semester, etc. Lots of places are talking about having only a pass/fail for the term. Exams themselves might be possible somehow, it wouldn’t surprise me to see them try to stage some at schools, with lowered density / increased duration of the examination period. On a similar note, I expect that large daycares will continue to not be allowed, but smaller ones might be able to open back up.
  • Large gatherings are almost certainly still not going to be allowed – no groups over N people. The only real question is what N will be. I expect we’ll have to play with it. It would really surprise me if N was as big as 100, I think 20-50 is much more reasonable. So that still means: nearly all festivals, conferences, sports events, clubs, churches, etc will remain canceled. In particular, for my life, it seems incredibly unlikely to me that we’ll be allowed or able to do Maker Festival in 2020. Even the Hacklab open house (20-40 people on a typical night, but not all at once) seems a bit sketchy.
  • I’m pretty optimistic that cafes, restaurants, and bars will be allowed to open, with some anti-crowding/sanitation measures, i.e. greatly reduced capacities, maybe half the tables are not allowed to be used in order to space out customers, and probably the serving staff will have to wear masks or face shields, really stepped up sanitation measures (doors, etc wiped down once+ an hour), etc. It’ll still be great to have even that available again though, in terms of us getting back to feeling normal. I certainly miss my social life a lot.
  • There will continue to be travel/border restrictions, but more importantly, there will be mandatory, managed 14-day isolation system in place for arriving travelers, just like they are doing now in parts of Asia. The government will literally put arrivals up in a hotel for 14 days, during which time they’ll see almost no-one. This treatment MIGHT be reserved only for travelers from places that still have outbreaks, but it might just be used for everyone too, it sort of depends on how much travel is actually happening, and on our perceived level of risk. It only takes one infected, irresponsible traveler to doom us to lockdown, if they don’t get with all of these measures (because they are not educated the way we will be).
  • Most office work will resume, though working at home will still be recommended where possible, with the goal to keep offices half-empty for more social distancing.  In fact in general, people will still be expected to social distance in public, so that little “cross the street dance” we’re doing when we’re walking around can be expected to continue. One way I can imagine this settling out on bigger streets is that one sidewalk goes one way, while the other goes the other way, and like when you’re driving, you “keep your safe distance” behind the previous person. Currently, things are a lot more chaotic than that, but I imagine we’ll have it figured out long before we open back up…
  • We’re almost certain to have some local flareups, which will result in travel bans to/from that area while it’s locked down in a new hammer cycle. Hopefully, local hammers are sufficient; the economic costs of a province-wide lockdown is just too huge.
  • In the fall, I expect Ontario WILL try to restart schools in some manner, with elaborate plans for sanitation, social distancing, etc. They’ll have months to figure it out, so hopefully, it’ll be well communicated, with high compliance, and actually work. Also hopefully by that time, most areas in Ontario won’t have had an actual case in months, so the objective risk will actually be very small.
  • This is also hopefully true for daycares, churches, medium-size gatherings (25-200 people), etc – at some point, with new measures in place, these kinds of things should be allowable again.

So overall that’s a kind of depressing “new reality” that we’ll be living in, of uncertain duration, but it’s hard to imagine how it could be any different, short of some kind of miracle cure or something.